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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623233
Report Date: 10/13/2022
Date Signed: 10/13/2022 11:42:45 AM

Document Has Been Signed on 10/13/2022 11:42 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PINE TOP INFANT & TODDLER CTR (INF)FACILITY NUMBER:
093623233
ADMINISTRATOR:JILL KIMEFACILITY TYPE:
830
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 644-1317
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 9DATE:
10/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jill KimeTIME COMPLETED:
11:55 PM
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On Thursday October 13th, 2022, Licensing Program Analysts (LPAs) Arianna Manabat and Soleil Marx met with Jill KIme for an unannounced annual inspection. At 9:30 AM, LPAs toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included 9 infant children in care with 3 staff and director. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 8:00 AM to 5:00 PM. Director 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.

LPAs observed a current Needs and Services plan for each infant in care. LPAs observed an Infant Sleeping Plan (LIC9227) for each child under 12 months of age. LPAs observed documentation that sleep checks were being conducted by staff every 15 minutes for all children under two. Bottles and baby food were kept in a refrigerator inside the classroom and LPAs observed properly labeled bottles with the child's name and date. All furnishings were in good condition. Staff stated that the bedding is changed daily. Infant diaper changing area is clean and within arm's reach of a sink. There is a one inch thick mat for the changing table with a vinyl surface. Toys are appropriate size with no small parts for the safety of the infants.

Classrooms all appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition. Drinking water was readily available to children both indoors and outdoors in water bottles. Bathrooms were clean and all sinks and toilets were in operating condition.

Continued on LIC 809-C......
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PINE TOP INFANT & TODDLER CTR (INF)
FACILITY NUMBER: 093623233
VISIT DATE: 10/13/2022
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The Director stated that there are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for AM and PM snack and the children bring their lunches from home on Fridays. LPAs observed the appropriate postings were visible to parents. LPAs reviewed staff files and transcripts and observed all staff being utilized as teachers were qualified. LPAs observed current Mandated Reporter certificates for staff and proof of immunization. At least one staff had a current Pediatric CPR and First Aid certification that expires on 02/2024. LPAs observed the sample of children’s files contained the appropriate documentation.

LPA discussed the safe sleep regulations with Facility Representative 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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

All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure.

No citations were issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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