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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407961
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:56:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:LITTLE PINES PRESCHOOL INFANT CENTERFACILITY NUMBER:
045407961
ADMINISTRATOR:TELLEZ, SHELLYFACILITY TYPE:
830
ADDRESS:2022 FRANKLIN STREETTELEPHONE:
(530) 965-2202
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:8CENSUS: DATE:
09/28/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shelly Tellez and (Andi) Andrea DraneTIME COMPLETED:
04:15 PM
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The facility pre-licensing inspection was conducted by Licensing Program Analyst’s (LPA) Snow. The applicant has applied for an infant license 8 infants. The facility was toured inside and outside. The center will operate from 7 am – 5:30 pm, M-F year-round. The infant program consists of 2 classroom(s) serving ages 0-24 months. The fire clearance was approved for 8 infants. The indoor and outdoor capacity measured for the requested capacity. Required postings (Parents Personal Rights, Emergency Disaster Plan, Earthquake Preparedness Checklist, Menu, etc.) listed on Form LIC 311A are posted. The applicant was advised that all staff are required to have a criminal background clearance on file with Community Care Licensing. The applicant is aware of the immediate $100 per day civil penalty for anyone providing care or supervision without a criminal record clearance. This is a combination infant preschool facility.
The infants will use the fenced outdoor play area. Sign-In/Out procedure were reviewed which is done electronically. The applicant/director understands that if a manual Sign-In/Out procedure is used; full legal signatures are required. There are pull alarms, and there is a working carbon monoxide detector and charged fire extinguisher in the facility rated at least the 2A10BC. All Exits are marked. There is 2 bathrooms with 2 toilets and 2 sinks for the preschool & there are potty training seats for the infants. There is a staff bathroom, which is separate. Water is available inside by use of water cups and outside via bottles and sippy cups.

Continued


SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: LITTLE PINES PRESCHOOL INFANT CENTER
FACILITY NUMBER: 045407961
VISIT DATE: 09/28/2021
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 Infants with symptoms of illness will not be accepted, and infants/toddlers who become ill during the day will be isolated in front staff office. The facility has sufficient cribs or mat/cot for each napping infant/toddler and bedding will be washing on site daily. Cribs will be free of loose objects. Infants will be supervised at all times while sleeping, and staff will physically check on sleeping infants every 15 minutes. The 15-minute checks will be documented on individual sleeping log and kept in the infant’s file. Infants under 12 months will be placed on their backs for sleep, and no infants will be swaddled, and the facility will have an Infant Sleeping Plan on file.

Snack are provided at the program and a menu will be posted. Age appropriate toys and activities are available for infants/toddlers. There is grass cushion material underneath the play structures sufficient to absorb falls. There are trees present to provide shade in the play yard. There are no bodies of water located on the property and none are to be added without prior notification and approval of the licensing agency. Incidental Medical Services (IMS) policy was discussed. 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) 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. This report, as well as the Guide to Safe Sleep Practices brochure, Lead Exposure Testing and COVID Guidance were reviewed and discussed with the applicant/director. All licensing reports are public information and must be made available upon request for at least three years.


Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department
The facility is ready for licensure effective September 29, 2021.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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