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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623234
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:20:03 PM

Document Has Been Signed on 12/04/2024 02:20 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PINE TOP INFANT & TODDLER CENTER (PS)FACILITY NUMBER:
093623234
ADMINISTRATOR/
DIRECTOR:		JILL KIMEFACILITY TYPE:
850
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 391-2604
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Morgan NewmanTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 12/04/2024, Licensing Program Analyst (LPA) Soleil Marx, met with Facility Representative, Morgan Newman, for an unannounced annual inspection. LPA observed facility in compliance with ratio with a census of four preschool age children being supervised by one fully qualified teacher. Facility hours of operation are Monday through Friday, 08:00 AM to 05:00 PM.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items were inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment were in safe, operable condition. Outdoor activity space and equipment were in good repair and free of loose or sharp parts. LPA observed adequate cushioning in areas underneath climbing equipment and adequate shaded areas provided. Toileting facilities were in safe, sanitary, and operating condition. Food preparation space was hygienic, and all food was protected against contamination. Facility provides AM/PM snack and children bring lunch from home. Uncontaminated drinking water was readily available to children both indoors and outdoors. Trash bins have tight-fitting lids. LPA observed an ample amount of first aid supplies available. LPA observed a carbon monoxide detector, smoke detector, and fully charged 2A10BC fire extinguisher within the facility. LPA observed authorized representatives are using full legal signatures on the sign in and out sheet. There are no bodies of water on the premises.

LPA reviewed facility records including child's records, personnel records, administrative records, and documents to be posted. LPA reviewed a sample of children’s files and observed that each child's file contained the required licensing documentation. LPA reviewed records for present staff. At least one staff member present today has current approved Pediatric CPR and First Aid certification expiring 04/2026. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. LPA observed a children's roster and fire drill log within the facility. Last fire drill was conducted 06/2024. LPA observed all required licensing documents were posted and visible to authorized representatives.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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: PINE TOP INFANT & TODDLER CENTER (PS)
FACILITY NUMBER: 093623234
VISIT DATE: 12/04/2024
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Facility Representative was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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 are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s inspection, LPA observed the facility was in compliance with Title 22 Regulations. No deficiencies were cited. Exit interview conducted and report was reviewed with the Facility Representative. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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