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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093623234
Report Date: 09/24/2025
Date Signed: 09/24/2025 02:09:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/16/2025 and conducted by Evaluator Andrea Cortez
COMPLAINT CONTROL NUMBER: 03-CC-20250716144849
FACILITY NAME:PINE TOP MONTESSORI ACADEMY (PS)FACILITY NUMBER:
093623234
ADMINISTRATOR:JILL KIMEFACILITY TYPE:
850
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 391-2604
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:29CENSUS: 15DATE:
09/24/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jill KimeTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Lack of Supervision-Due to lack of supervision, child touched another child inappropriately
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Andrea Cortez met with Director, Jill Kime, for the purpose of delivering findings to the complaint investigation alleging lack of supervision LPA explained there was preponderance of evidence determined during interviews therefore the allegation is substantiated.

During today's inspection, LPA observed children napping in 4 classrooms. Preschool 8:2, Room C: 7:2, Room B infant 3:1, and Room A infant 3:1

Based upon evidence obtained through LPA observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

One Type A deficiency is being cited on the 9099-d page. Appeal Rights provided. Report was reviewed with Director. Exit interview conducted. A notice of site visit was provided and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 03-CC-20250716144849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 MONTESSORI ACADEMY (PS)
FACILITY NUMBER: 093623234
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2025
Section Cited
CCR
101229(a)(1)
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101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Licensee to submit a written Statement adhearing to 101229(a)(1) by 9/25/25
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/16/2025 and conducted by Evaluator Andrea Cortez
COMPLAINT CONTROL NUMBER: 03-CC-20250716144849

FACILITY NAME:PINE TOP MONTESSORI ACADEMY (PS)FACILITY NUMBER:
093623234
ADMINISTRATOR:JILL KIMEFACILITY TYPE:
850
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 391-2604
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:29CENSUS: 15DATE:
09/24/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jill KimeTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Personal Rights-Unqualified staff are supervising children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Andrea Cortez made an unannounced inspection to the facility to deliver the findings for complaint allegation mentioned above. LPA met with Director Jill Kime and explained there was not preponderance of evidence determined during interviews therefore the allegation is unsubstantiated.

Based upon interviews conducted, there is not a preponderance of evidence to prove the allegations did or did not occur, therefore the above allegation is UNSUBSTANTIATED.

Exit interview conducted and notice of site visit given. Notice of site is to be posted for 30 day.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3