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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 030316248
Report Date: 11/15/2019
Date Signed: 11/15/2019 04:27:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:PIONEER MONTESSORIFACILITY NUMBER:
030316248
ADMINISTRATOR:MACDONALD, ELLEN GAYFACILITY TYPE:
850
ADDRESS:23714 HWY 88TELEPHONE:
(209) 295-4144
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY:40CENSUS: 8DATE:
11/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Ellen MacdonaldTIME COMPLETED:
04:35 PM
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Licensing Program Analysts (LPA) Aruna Sridharan and Licensing Program Manager Sharon Ogbodo met with Ellen MacDonald for the purpose of an unannounced annual inspection. Today’s census was 8 children and one staff member, who has been fingerprint cleared through Community Care Licensing LPA toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. LPA observed appropriate ratios, care and supervision, and capacity during the visit. The hours of operation are Monday through Friday 7:30am to 6:00pm.

Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. First Aid was centrally located but inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with wood chips to absorb falls. The Director stated there are no firearms or bodies of water on the property. There are 4 toilets and 4 sinks. Toileting facilities were in operating, safe, and sanitary condition. Children bring their own snacks and lunch. Uncontaminated drinking water is readily available to children both indoors and outdoors. LPA observed Sign In/Out Sheet with signatures, times, and dates.

LPA reviewed 5 children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative
Report continues on 809C......
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: PIONEER MONTESSORI
FACILITY NUMBER: 030316248
VISIT DATE: 11/15/2019
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At least one staff member present today had current Pediatric CPR and First Aid certification (expires 02/21). All staff currently employed with the facility have criminal record clearances and proof of immunizations. LPA also reviewed documentation of qualifications including education and experience. LPA discussed the Departmental inspection authority, and also informed the Licensee that any changes regarding the Center Director or their Designee must be reported to Department within 10 working days.
LPA discussed Departments inspection authority regulations with the Director and informed her that if any changes occur regarding the Designee/Director or an employee acting in their absence must be reported to Department within 10 working days.

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.



LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.



Report continues on 809C.........
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: PIONEER MONTESSORI
FACILITY NUMBER: 030316248
VISIT DATE: 11/15/2019
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LPA discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is not currently providing IMS; however, LPA discussed the IMS policy. For IMS information see the Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and Medication Regulations 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ), 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

LPA advised the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com.



No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report and provided copies to the facility. An exit interview was conducted. Appeal Rights were provided and Notice of Site posted and the Director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3