093614550-4-28-2021-03-CC-MMAA-C2L25R-20210430170556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093614550
Report Date: 04/27/2021
Date Signed: 04/28/2021 01:36:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/29/2021 and conducted by Evaluator Michelle Pascual

COMPLAINT CONTROL NUMBER: 03-CC-20210129102251

FACILITY NAME:	PINE TOP MONTESSORI SCHOOL		FACILITY NUMBER:	093614550
ADMINISTRATOR:	KIME, JILL		FACILITY TYPE:	850
ADDRESS:	6526 PONY EXPRESS TRAIL		TELEPHONE:	(530) 903-3106
CITY:	POLLOCK PINES	STATE: CA	ZIP CODE:	95726
CAPACITY:	30	CENSUS: 22	DATE:	04/27/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Jill Kime		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Personal Rights- Facility is not ensuring the personal rights of children in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michelle Pascual met with owner/Director Jill Kime via Facetime, to deliver the findings for the allegation of “Facility is not ensuring the personal rights of children in care.”

The census was 22 children and four staff.

According to the complaint, the owner brings their dog(s) into the facility and it has free roam of the play yard and defecates on the ground. Further, the feces is not cleaned up in a timely manner, therefore it is transferred to the playground equipment and to the children’s clothes by way of their shoes. The allegation further states that a rooster was present at the facility and was aggressive as it had attacked children in care. The allegation stated that there was concern for children’s safety as it was not being ensured. During the course of the investigation which included interviews with children, staff and parents and a site visit, the preponderance of evidence standard has been met therefore the above allegation is found to SUBSTANTIATED.

California Code of Regulations (Title 22 Division and Chapter number) are being cited on the attached LIC 9099-D.

This report must be posted for 30 days and must be provided to the parents of the children currently in care, as well as the parents of children enrolled over the next 12 months. An exit interview was conducted in which the report was reviewed and discussed with the Licensee.
Appeal rights were discussed and a printed version was given to licensee.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 03-CC-20210129102251

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PINE TOP MONTESSORI SCHOOL	FACILITY NUMBER: 093614550
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/29/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.	1 2 3 4 5 6 7	Owner/Director will not have a rooster on the premisis and has decided that she will no longer bring her dog into the facility. Owner is submitting a signed letter which will serve to confirm this.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: consistent admissions from staff, parents and children stating there was an aggressive rooster who attacked children and feces on play yard equipment which transferred to children's clothes.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

LIC9099 (FAS) - (06/04)

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