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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 030319700
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:41:49 AM

Document Has Been Signed on 09/14/2023 11:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PIONEER STATE PRESCHOOLFACILITY NUMBER:
030319700
ADMINISTRATOR:JESSICA VAUGHNFACILITY TYPE:
850
ADDRESS:24625 HIGHWAY 88TELEPHONE:
(209) 295-6506
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Director: Dewalt, JeniTIME COMPLETED:
11:55 AM
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Licensing Program Analysts (LPA's) Mariya Melnichuk and Lauren Scott met with Director, Jeni DeWalt on 9/14/2023 for the purpose of an unannounced plan of correction inspection to clear a Type B deficiency, which was issued on 8/22/23 for lead exceedance.

All individuals subject to criminal background review have obtained a criminal record clearance. Director was reminded that all adults 18 years and older, working in the center, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.



During today's inspection LPA's toured all areas accessible to children in care. The facility tested for elevated levels of lead for outlets inside the classroom and in the outdoor fountains. The facility flushed and re-tested for their outlets inside the classroom. The outdoor fountains are shared by the elementary school and are now shut off.

All deficiencies cited on 8/22/23 are cleared, effective today. Proof of correction letter was provided. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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