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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 030319700
Report Date: 06/22/2023
Date Signed: 06/22/2023 10:07:06 AM


Document Has Been Signed on 06/22/2023 10:07 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PIONEER STATE PRESCHOOLFACILITY NUMBER:
030319700
ADMINISTRATOR:JESSICA VAUGHNFACILITY TYPE:
850
ADDRESS:24625 HIGHWAY 88TELEPHONE:
(209) 295-6503
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY:24CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle PechettTIME COMPLETED:
10:30 AM
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Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Mariya Melnichuk met with Licensee Representative Michelle Pechette for the purpose of a case management inspection. Licensee requests a room change. Licensee is not making any changes to the capacity. The preschool program is located at Pioneer Elementary School. The fire clearance was granted and received on 6/14/2023. The program currently operates Monday through Friday from 8:00 a.m. to 11:00 a.m.

INDOOR ACTIVITY SPACE:
There is one preschool classroom located in room #6. AS observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. AS measured room #6. The total classroom space contains a total of 1,236 square feet, which will accommodate the current licensed capacity of 24 preschool children. There are one toilet and one sink for the children. AS observed a Shared Bathroom Waiver on file. There is a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Licensee 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Representative, Michelle Pechette.

Effective today, 6/22/2023, AS will approve the room change.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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