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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623234
Report Date: 01/23/2025
Date Signed: 01/23/2025 01:59:36 PM

Document Has Been Signed on 01/23/2025 01:59 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: 8DATE:
01/23/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Morgan NewmanTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On January 23, 2025, Licensing Program Analyst (LPA) Soleil Marx and Regional Manager (RM) Natalie Dunaway, met with Facility Representative, Morgan Newman, for the purpose of an unannounced capacity increase case management inspection. This facility has requested a name change to Pine Top Montessori Academy in addition to the capacity increase.

This is an application requesting for a capacity increase from 14 preschool age children to 29 children, ages two to entry into first grade. The fire clearance was granted on 11/13/2024 from El Dorado County Fire Prevention Department. There is one existing preschool classroom, the licensee is adding one additional detached preschool classroom.

The existing preschool classroom was previously measured in September of 2021 as 515.023 square feet . The new classroom contains a measurement of 600 square feet. The total classroom space contains a total of 1,115.023 square feet, which will accommodate the requested capacity of 29 children. There are 4 toilets and 2 operating sinks available to children, and a separate staff restroom is available.

The total outdoor activity space was previously measured in September of 2021 as 21,375 square feet, which will accommodate the requested capacity of 29 preschool age children.

This facility will be approved for a capacity of 29 preschool age children pending the following:

List of Furniture/Materials
Verification that outstanding fees were paid
Pictures of room set up with furniture/materials
Wall heater barrier secured to wall
Final manager review

Exit interview conducted and report reviewed with Facility Representative. Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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