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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034501027
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:47:22 PM

Document Has Been Signed on 01/30/2024 12:47 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 PRESCHOOLFACILITY NUMBER:
034501027
ADMINISTRATOR:ALLEN, KIRBIEFACILITY TYPE:
840
ADDRESS:23714 STATE HIGHWAY 88TELEPHONE:
(209) 457-0995
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 20DATE:
01/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Erica MillerTIME COMPLETED:
11:15 AM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and Licensing Program Analyst (LPA) Elizabeth Santiago met with Licensee Erica Miller for the purpose of an announced pre-licensing and change of capacity inspection. Licensee requests a change of capacity for the current preschool component (034500913) to serve 36 children from age two years to entry into kindergarten and add a school-age component to serve 14 children enrolled in kindergarten and above. The fire clearances (STD850s) were granted and received on 1/8/2024. LPA informed Licensee that the facility will be converted to a single child care center license under facility number 034501027, therefore LPA will be closing the current preschool facility number 034500913.

LPA observed a census of 20 preschool children with two teachers.The program operates Monday through Friday from 7:30 a.m. to 5:30 p.m. The facility does not provide meals, therefore the parents are required to bring morning/afternoon snack and lunch for their child. 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.

INDOOR ACTIVITY SPACE:
There is one preschool classroom (Room A) and four school-age classrooms (Room B, C, D, E). LPA observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. There is a first aid kit located in the storage cupboard in Room A and between Room B and C. Medications will be stored in the kitchen in a locked box or in the refrigerator if needed. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Licensee stated there are no poisons or firearms on the premises. Licensee stated staff use water pitchers and cups for the children indoors and outdoors. LPA observed a functional carbon monoxide detector in Room A. LPA observed an electronic sign-in/sign-out system.

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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 3
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: 034501027
VISIT DATE: 01/30/2024
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LPA used current classrooms measurements from preschool facility report dated 8/2/2023 (034500913), therefore LPA did not take measurements. The total preschool classroom space contains a total of 1,514 square feet and the total school-age classroom spaces contain a total of 602 square feet, which will accommodate Licensee’s request for 36 preschool children and 14 school-age children. There are two toilets, one urinal, two sinks, and one sink located in Room A for the preschool children. There is one toilet and one sink for the school-age children located in the hallway. There is a separate private restroom for the staff located in Room E. Children who become ill during the day will be isolated in Room C and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one preschool yard and one school-age yard on the property. The outdoor play areas are fenced with a chain link fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There are two play structures located on the preschool yard which is approved for ages two years and above. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

LPA used current outdoor measurements from preschool facility report dated 8/2/2023 (034500913), therefore LPA did not take measurements. The preschool yard contains a total of 2,818 square feet and the school-age yard contains a total of 2,393 square feet, which will accommodate Licensee's request for 36 preschool children and 14 school-age children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 034501027
VISIT DATE: 01/30/2024
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LPA discussed the following: 100% supervision is required at all times, including in the bathroom; 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.

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.

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 the Licensee, Erica Miller.

Effective today, 1/30/2024, LPA will approve the preschool component change of capacity for 36 preschool children and add a school-age component of 14 school-age children.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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