CAL POLY HUMBOLDT CHILDREN'S CENTER RM#104,108,125

Type A citation - immediate risk to health, safety, or personal rights

Type A citation - immediate risk to health, safety, or personal rights

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25An unannounced case management inspection was conducted today 05/28/2025 at 1:00 p.m. by Licensing Program Analysts (LPA) Noah Wheeler and Kiriko Lynch. LPAs met with facility representative Betsy Wilson in response to an Unusual Incident Report self-reported by the facility on 05/01/2025, and received by the Department. Facility representative stated the classroom was transitioning from outside to inside for snack and staff miscounted during the transition. She stated a teacher (S2) was leaving her shift noticed one child (C1) was on the playground, and immediately notified classroom staff. She stated staff immediately went outside and found C1 retrieving a toy near the sandbox, and child was brought inside after approximately 5-10 minutes of being left unattended. The facility representative was interviewed on 05/28/2025, and stated that on 05/01/2025 at approximately 1:00 p.m., one child (C1) were left outside during transition, and staff did not notice the child was missing for approximately 5-10 minutes. One additional staff (S1) were also interviewed on 05/28/2025 and stated C1 was left unattended for approximately 5-15 minutes from outside to inside transition into snack. Continued on 809-C NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta NAME OF LICENSING PROGRAM ANALYST: Noah Wheeler LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25An unannounced case management inspection was conducted today 05/28/2025 at 1:00 p.m. by Licensing Program Analysts (LPA) Noah Wheeler and Kiriko Lynch. LPAs met with facility representative Betsy Wilson in response to an Unusual Incident Report self-reported by the facility on 05/01/2025, and received by the Department. Facility representative stated the classroom was transitioning from outside to inside for snack and staff miscounted during the transition. She stated a teacher (S2) was leaving her shift noticed one child (C1) was on the playground, and immediately notified classroom staff. She stated staff immediately went outside and found C1 retrieving a toy near the sandbox, and child was brought inside after approximately 5-10 minutes of being left unattended. The facility representative was interviewed on 05/28/2025, and stated that on 05/01/2025 at approximately 1:00 p.m., one child (C1) were left outside during transition, and staff did not notice the child was missing for approximately 5-10 minutes. One additional staff (S1) were also interviewed on 05/28/2025 and stated C1 was left unattended for approximately 5-15 minutes from outside to inside transition into snack. Continued on 809-C NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta NAME OF LICENSING PROGRAM ANALYST: Noah Wheeler LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25An unannounced case management inspection was conducted today 05/28/2025 at 1:00 p.m. by Licensing Program Analysts (LPA) Noah Wheeler and Kiriko Lynch. LPAs met with facility representative Betsy Wilson in response to an Unusual Incident Report self-reported by the facility on 05/01/2025, and received by the Department. Facility representative stated the classroom was transitioning from outside to inside for snack and staff miscounted during the transition. She stated a teacher (S2) was leaving her shift noticed one child (C1) was on the playground, and immediately notified classroom staff. She stated staff immediately went outside and found C1 retrieving a toy near the sandbox, and child was brought inside after approximately 5-10 minutes of being left unattended. The facility representative was interviewed on 05/28/2025, and stated that on 05/01/2025 at approximately 1:00 p.m., one child (C1) were left outside during transition, and staff did not notice the child was missing for approximately 5-10 minutes. One additional staff (S1) were also interviewed on 05/28/2025 and stated C1 was left unattended for approximately 5-15 minutes from outside to inside transition into snack. Continued on 809-C NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta NAME OF LICENSING PROGRAM ANALYST: Noah Wheeler LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25An unannounced case management inspection was conducted today 05/28/2025 at 1:00 p.m. by Licensing Program Analysts (LPA) Noah Wheeler and Kiriko Lynch. LPAs met with facility representative Betsy Wilson in response to an Unusual Incident Report self-reported by the facility on 05/01/2025, and received by the Department. Facility representative stated the classroom was transitioning from outside to inside for snack and staff miscounted during the transition. She stated a teacher (S2) was leaving her shift noticed one child (C1) was on the playground, and immediately notified classroom staff. She stated staff immediately went outside and found C1 retrieving a toy near the sandbox, and child was brought inside after approximately 5-10 minutes of being left unattended. The facility representative was interviewed on 05/28/2025, and stated that on 05/01/2025 at approximately 1:00 p.m., one child (C1) were left outside during transition, and staff did not notice the child was missing for approximately 5-10 minutes. One additional staff (S1) were also interviewed on 05/28/2025 and stated C1 was left unattended for approximately 5-15 minutes from outside to inside transition into snack. Continued on 809-C NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta NAME OF LICENSING PROGRAM ANALYST: Noah Wheeler LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 4 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