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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090321692
Report Date: 08/08/2022
Date Signed: 08/08/2022 10:44:51 AM


Document Has Been Signed on 08/08/2022 10:44 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:PINEWOOD HEAD STARTFACILITY NUMBER:
090321692
ADMINISTRATOR:TOMBS/STOWEFACILITY TYPE:
850
ADDRESS:6181 PINE ST.TELEPHONE:
(916) 647-0312
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:20CENSUS: 0DATE:
08/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Colleen BraunbeckTIME COMPLETED:
11:00 AM
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At 10:00 AM on Monday, August 8th, 2022, Licensing Program Analyst (LPA) Arianna Manabat met with Program Coordinator, Colleen Braunbeck, for the purpose of an announced case management - licensee initiated inspection. Licensee requested a room change from the Pinewood portable. During today's visit there were no children in care. The facility's current hours of operation are Monday through Friday from 8:00 AM to 2:30 PM.

A health and safety inspection was conducted in all areas accessible to children. LPA observed the facility had a sufficient amount of furniture, toys, and cubbies in the classrooms. LPA observed tables and chairs suitable for preschool sized children. LPA observed disinfectants and medications are inaccessible and appropriately stored. The facility does not currently serve children with incidental medical services but does have a plan on file.

The site is using the bathroom with four sinks, five toilets, and three urinals.

The total square footage for the classroom is 877.50 square feet which will accommodate 20 preschool children.

LPAs observed the outdoor play area is fenced and equipped with a sufficient amount of play equipment and toys. The outdoor space was previously measured and is the was previously used by the site, which will accommodate 20 children. (Please see pre-licensing evaluation on file for square footage.)

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. Notice of Site was provided and must remain posted for 30 days.
As of August 8th, 2022, the facility is licensed to provide care for students ages two to entry into kindergarten.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022
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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