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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090321692
Report Date: 07/26/2024
Date Signed: 07/26/2024 11:04:53 AM

Document Has Been Signed on 07/26/2024 11:04 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PINEWOOD HEAD STARTFACILITY NUMBER:
090321692
ADMINISTRATOR/
DIRECTOR:		TOMBS/STOWEFACILITY TYPE:
850
ADDRESS:6181 PINE ST. #25TELEPHONE:
(916) 647-0312
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
07/26/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Colleen Braunbeck and Jenny PettitTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 7/26/2024 at approximately 10:00am, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and LPA Soleil Marx met with Licensee Representatives Jenny Pettit and Colleen Braunbeck for the purpose of an announced change of capacity case management inspection. The Applicant is requesting a total of 24 preschool students and a room change to Pinewood Portable. The fire clearance was received and granted. The program operates Monday through Friday 8:00 AM to 3:30 PM and it located on the Pinewood elementary school campus.

INDOOR ACTIVITY SPACE:
There is one building on site that is used by the facility. The classroom is located in the Pinewood Portable. During today's visit, LPAs observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. CAB LPA measured the indoor space for a total of 1,203.37 square feet, which will accommodate Licensee’s request for 24 preschoolers. There are a total of 3 sinks and 2 toilets. There is a private restroom for staff located inside of the portable and it is clearly labeled as "staff restroom".

OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on site, the main yard with a play structure that is manufactured for ages 2-5 years of age and another that is called the "side yard". The "side yard" is exclusive to the preschool program and the "main yard" is shared by the elementary school. There is a shared space waiver on file. The outdoor play area is encompassed by the main school fence that is at least four feet tall. The play yards are distinguished by partial chain linked fencing that surrounds the section of play structure/space.

During this visit, LPAs observed that the play structure did not currently have a substrates under the structure to cushion a fall. The facility representative stated that the substrates would later be installed and that they would send pictures to verify the installation.

Report continues on LIC809-C....
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PINEWOOD HEAD START
FACILITY NUMBER: 090321692
VISIT DATE: 07/26/2024
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Facility Representative stated there are no firearms, weapons, or bodies of water on the facility premises. LPAs did not observe sufficient shaded areas to the outdoor play area. The facility representative stated that there will be an canopy installed on the side yard and that they would provide proof of installment to LPAs for review. Additionally, turf will be installed in the side yard and proof will be sent to LPA Manabat.

During today's visit, LPAs measured a combined total of 9072.88 square feet for the preschool yards which will accommodate Licensee’s request for 24 preschoolers.

Licensee Representative was reminded that all adults 18 and over, 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 Child Care 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Prior to issuing a license, the following conditions must be submitted:

1. Pending Licensing Program Manager's final review.
2. Proof of running water inside of the children's restroom.
3. Installment of the canopy shading on the side yard.
4. Proof of substrates under the existing play structure on the main yard.

Exit interview conducted and report was reviewed with the Licensee Representative.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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