034500788-3-19-2025-53-CC-ASIS-DEWS2D-20250319132922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 034500788
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:29:36 PM

Document Has Been Signed on 03/19/2025 01:29 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MOTHER LODE MOUNTAIN TOTS PRESCHOOL		FACILITY NUMBER:	034500788
ADMINISTRATOR/ DIRECTOR:	ALLEN, KIRBIE		FACILITY TYPE:	860
ADDRESS:	23714 STATE HIGHWAY 88		TELEPHONE:	(209) 295-1230
CITY:	PIONEER	STATE: CA	ZIP CODE:	95666
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 25	DATE:	03/19/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Erica Miller		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Licensee Erica Miller for the purpose of a pre-licensing change of ownership inspection due to the filing changing from an LLC to a Profit-Corporation. Licensee requests an infant component for 4 infants ages 0-24 months, a preschool component for 36 preschool children ages two years to entry into first grade, and a school-age component for 8 school-age children in first grade to twelve years for a total capacity of 48. The program operates Monday through Friday from 7:30 a.m. to 5:30 p.m. The fire clearance was granted and received on 2/6/2025. Parents will provide all meals including formula, breast milk, and baby food for their children. LPA reviewed with Licensee the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. INDOOR ACTIVITY SPACE: There is one infant classroom located in Room B and a crib room located in Room C, one preschool classroom located in Room A, and two school-age classrooms located in Rooms D & E. Report continues on LIC809-C page 2.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE MOUNTAIN TOTS PRESCHOOL	FACILITY NUMBER: 034500788
	VISIT DATE: 03/19/2025

NARRATIVE

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Page 2.

LPA observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, and napping cots. LPA observed three cribs located in the crib Room C. There is a first aid kit in the kitchen, infant, and preschool rooms. Medications will be in the lock box in the kitchen. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Licensee stated there are no poisons or firearms on the premises. Licensee stated there will be a water pitcher and cups available in the classroom. LPA observed a functional carbon monoxide detector in the preschool classroom. LPA observed an electronic sign-in/sign-out system.

LPA used current measurements from report dated 1/30/2024 under facility number 034501027, therefore LPA did not take measurements of the infant classroom (Room B). The total classroom space contains a total of 246 square feet, which will accommodate Licensees request for 4 infants. LPA observed one sink within arm’s reach of a changing table located in Room B.

LPA used current measurements from report dated 1/30/2024 under facility number 034501027, therefore LPA did not take measurements of the preschool classroom. The total classroom space contains a total of 1,514 square feet, which will accommodate Licensees request for 36 preschool children. LPA observed two toilets + one urinal and three sinks for the preschool children located preschool classroom and preschool bathroom.

LPA measured the school-age classrooms, Rooms D & E. The total classroom spaces contain a total of 280 square feet, which will accommodate Licensees request for 8 school-age children. LPA observed one toilet and one sink in the school-age bathroom located in the hallway. There is a separate private restroom for the staff located Room E. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Preschool and school-age children who become ill during the day will be isolated in the nap area, infants will be isolated in the all-cove within the classroom and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are three outdoor areas on the property, Infant Yard, Preschool Yard, and School-age yard. The outdoor play area is fenced with a chain link fence that is at least four feet tall.

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE MOUNTAIN TOTS PRESCHOOL	FACILITY NUMBER: 034500788
	VISIT DATE: 03/19/2025

NARRATIVE

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LPA also observed a small chain link and wrought iron fence that separates the yards from one another. There are two play structures located on the preschool yard which is approved for children two years and above. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

LPA measured the infant outdoor activity space. The outdoor play area contains a total of 793 square feet, which will accommodate Licensee's request for 4 infants. LPA used current measurements from report dated 1/30/2024 under facility number 034501027, therefore LPA did not take measurements of the preschool outdoor activity space. The outdoor play area contains a total of 2,818 square feet, which will accommodate Licensee’s request for 36 preschool children. LPA measured the school-age outdoor activity space. The outdoor play area contains a total of 1,097 square feet, which will accommodate Licensee’s request for 8 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Licensee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC809-C page 4.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE MOUNTAIN TOTS PRESCHOOL	FACILITY NUMBER: 034500788
	VISIT DATE: 03/19/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Written Directives for Lead Testing in Child Care Centers: Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Licensee Erica Miller.

Effective today, 3/19/2025, the facility is approved for 4 infants ages 0-24 months, 36 preschool children ages two years to entry into first grade, and 8 school-age children in first grade to twelve years.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

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