103801183-1-9-2025-04-CC-BTAE-DCRRY6-20250109122551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103801183
Report Date: 01/09/2025
Date Signed: 01/09/2025 12:25:57 PM

Document Has Been Signed on 01/09/2025 12:25 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	PINE RIDGE TRAILER TOTS		FACILITY NUMBER:	103801183
ADMINISTRATOR/ DIRECTOR:	ROSA, STEVE		FACILITY TYPE:	850
ADDRESS:	45828 AUBERRY ROAD		TELEPHONE:	(559) 841-2444
CITY:	AUBERRY	STATE: CA	ZIP CODE:	93602
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 11	DATE:	01/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Steve Rosa		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On 1/9/2025 Licensing Program Analyst (LPA) Brandon Tate conducted an unannounced Annual Random Inspection. LPA Tate signed into the visitor list and was met with Director Steve Rosa. LPA Tate discussed the reason for today’s visit with Director Rosa. The licensed facility was inspected inside and outside. A census was taken of 11 children present during today’s inspection. This is a Public Agency that has a current fire clearance on file. Days and hours of operation are Monday through Friday from 0830 to 1230 hours.

LPA Tate began his inspection with file reviews. A sample of children records was obtained and thoroughly reviewed. All necessary emergency contact information, consent forms, and proper documentation were within. LPA Tate did a thorough file review for staff. Staff have the necessary experience and education to perform their job duties. There is at least one qualified staff present at all times that has a current Pediatric CPR/First Aid Certification. All staff have immunization verification and necessary forms on file per California State Regulatory Standards.

LPA Tate then inspected the licensed facility’s indoor activity space. LPA Tate observed age-appropriate toys for children in care. The facility was maintained to regulatory standard cleanliness and LPA Tate did not observe any hazards or sharp objects that could potentially harm children in care. LPA Tate observed sufficient cubby space for children and personal belongings were kept separate. LPA Tate observed children’s lunch bags and personal items with the child’s names written for identification. There was a functioning carbon monoxide alarm and fire extinguisher within the indoor activity space. LPA Tate observed drinking water accessible to children and record review showed that lead testing has been conducted for the licensed facility.

LPA Tate inspected the restroom and observed the restroom to be clean and sanitized. There was functioning sinks and toilets within that were temperature compliant with California Code of Regulations. LPA Tate observed sufficient toilet and sink ratio for children in care. LPA Tate did not observe any hazards that could potentially harm children in care.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Brandon Tate
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: PINE RIDGE TRAILER TOTS	FACILITY NUMBER: 103801183
	VISIT DATE: 01/09/2025

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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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Director Rosa 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Appeal rights were given. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Steve Rosa.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Brandon Tate
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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