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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622153
Report Date: 03/20/2024
Date Signed: 03/20/2024 10:02:29 AM

Document Has Been Signed on 03/20/2024 10:02 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:
313622153
ADMINISTRATOR:MARCI PILGRIMFACILITY TYPE:
850
ADDRESS:5370 DOUGLAS BLVDTELEPHONE:
(916) 605-0217
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 63DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marci PilgrimTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jeremey McClain met with facility representative Marci Pilgrim for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPA observed 63 children, supervised by 11 staff members in separate classrooms.

On 03/05/2024 it was reported that a child suffered a bump on their head while on the playground. Due to the child’s condition, they were later observed at the hospital although the bump was not major nor bleeding. The child did not show signs of being concussed or having a serious injury. Incidental medical services were administered, and parents were contacted immediately.

During today’s inspection, LPA attempted to interview the child. LPA reviewed the child’s file and the care plan including the Incidental Medical Services. LPA interviewed staff that witnessed the incident.

Although there is a concern, there is not sufficient evidence to determine that there was a lack of supervision. LPA discussed supervision and care for the child.

An exit interview was conducted and this report was reviewed with facility representative Marci Pilgrim .
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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