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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034501027
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:50:33 PM

Document Has Been Signed on 03/12/2025 12:50 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/
DIRECTOR:		ALLEN, KIRBIEFACILITY TYPE:
860
ADDRESS:23714 STATE HIGHWAY 88TELEPHONE:
(209) 457-0995
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 31DATE:
03/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Owner, Erica MillerTIME VISIT/
INSPECTION COMPLETED:
01:09 PM
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Licensing Program Analyst (LPA) Elizabeth Santiago met with Owner, Erica Miller to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 03/10/2025. During today's visit the facility was toured. Present were 31 children in care and 5 staff.

LPA interviewed staff who were present during the incident and requested documentation. LPA reviewed and discussed this report with the Owner, Erica Miller.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

Facility evaluation report was reviewed and discussed with Owner, Erica Miller. Exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements may result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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