581376456-12-9-2025-13-CC-TDUA-DP7VTM-20251209154321

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 581376456
Report Date: 12/09/2025
Date Signed: 12/09/2025 03:43:27 PM

Document Has Been Signed on 12/09/2025 03:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	YUBA COLLEGE CHILD CARE CENTER		FACILITY NUMBER:	581376456
ADMINISTRATOR/ DIRECTOR:	STANIS, KAREN		FACILITY TYPE:	850
ADDRESS:	2088 NORTH BEALE ROAD		TELEPHONE:	(530) 634-7741
CITY:	MARYSVILLE	STATE: CA	ZIP CODE:	95901
CAPACITY: 87	TOTAL ENROLLED CHILDREN: 87	CENSUS: 5	DATE:	12/09/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:05 PM
MET WITH:	Renee Mc Kenzie		TIME VISIT/ INSPECTION COMPLETED:	03:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced case management inspection was conducted today at 2:05pm by Licensing Program Analyst (LPA), Tammy Dutra. LPA met with facility representative Renee McKenzie in response to an Unusual Incident Report received by the Department on 10/16/25. A child in care (C1) was climbing on the climbing structure lost their footing and hit their head causing a bump on the forehead. The facility representative was interviewed on 12/9/25 at 2:28pm and stated that on 10/16/25 at 10:25am a child in care (C1) fell on the climbing structure and injured their forehead. Facility representative stated that C1's parents were immediately notified and child was given first aid. C1's parents sought medical attention and C1 was cleared medically to return to the facility the following day. One staff (S1) was interviewed on 12/9/25 and stated that C1 was exiting the play structure and on the way down the stairs C1 lost their footing and hit the hand rail at the bottom. C1 was escorted inside and site supervisor was contacted. First aid was applied and parent was contacted. C1 was picked up immediately and taken to seek medical care.

NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta
NAME OF LICENSING PROGRAM ANALYST: Tammy Dutra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: YUBA COLLEGE CHILD CARE CENTER	FACILITY NUMBER: 581376456
	VISIT DATE: 12/09/2025

NARRATIVE

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C1 was released from medical care and returned to school the following day. S1 did not feel the injury could have been prevented.

During today’s inspection, the facility was toured and the play equipment was observed to be age appropriate. LPA received a copy of the incident report from the site supervisor. LPA took photos of the play equipment and observed children playing on the equipment. LPA observed staff actively supervising children in care and coaching them on safety precautions to prevent injury. LPA reviewed sign in and sign out sheets and determined there were 12 children with four staff present.

LPA attempted to contact C1's parents but was unsuccessful in reaching them. LPA will follow up and attempt further contact to ensure parents have no concerns regarding the care and supervision of their child.

Based on interviews and observation LPA determined the play equipment and ratio requirements for staffing were being met. Staff provided first aid and immediately notified C1's parents of the injury to ensure care was provided. Ratio and staffing requirements were followed per Title 22 regulations. It has been determined this injury was an accident and could not have been prevented.

There were no deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with the facility representative Renee McKenzie. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta
NAME OF LICENSING PROGRAM ANALYST: Tammy Dutra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

LIC809 (FAS) - (06/04)

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