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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622152
Report Date: 05/24/2024
Date Signed: 05/24/2024 10:05:03 AM

Document Has Been Signed on 05/24/2024 10:05 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LITTLE SUNSHINE'S PLAYHOUSE & PS - GRANITE BAYFACILITY NUMBER:
313622152
ADMINISTRATOR/
DIRECTOR:		MARCI PILGRIMFACILITY TYPE:
830
ADDRESS:5370 DOUGLAS BLVDTELEPHONE:
(916) 605-0217
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 26DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Marci PilgrimTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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icensing Program Analyst (LPA) Jeremey McClain met with facility representative Marci Pilgrim for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPA observed 26 infants supervised by nine staff staff members.

The facility self -reported that 05/10/2024, child C1 suffered a superficial partial thickness burn (synonymous with second degree burns) to both feet. Interviews with staff and parents confirmed that the on 05/10/2024, C1 walked across the playground barefoot for approximately two minutes before Staff 1 heard C1 crying and observed their injury. Staff attended to C1 immediately and contacted their parents, and C1 was later given medical attention and a diagnosis. Interviews were consistent that staff did not observe the playground for potential hazards or safety precautions before allowing C1 to walk outside barefoot.

LPA Jeremey McClain informed facility representative Marci Pilgrim that this report dated 05/24/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Jeremey McClain informed facility representative Marci Pilgrim to provide a copy of this licensing report dated 05/24/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with facility representative Marci Pilgrim. LPA provided a Notice of Site Visit that shall remain posted for 30 days. LPA provided and discussed appeal rights with facility representative.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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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Document Has Been Signed on 05/24/2024 10:05 AM - It Cannot Be Edited


Created By: Jeremey McClain On 05/24/2024 at 09:32 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE SUNSHINE'S PLAYHOUSE & PS - GRANITE BAY
FACILITY NUMBER: 313622152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/27/2024
Section Cited
CCR
101223(a)(2)

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Personal Rights.(a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as
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Facility is requireing all children to wear shoes before going to the playground. The facility has also got sewer caps to prevent possible injury. The facility has also developed procedures for staff to determine if conditions on the playground are safe or not for children.
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evidenced by the second degree burns C1 sustained on 05/10/2024, when they were allowed to walk on the playground barefoot. This posed and immediate risk to health, safety, or personal rights of children in care.
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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.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024


LIC809 (FAS) - (06/04)
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