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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093614550
Report Date: 05/26/2021
Date Signed: 05/27/2021 04:45:42 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
03/09/2021 and conducted by Evaluator Michelle Pascual
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210309150708
FACILITY NAME:PINE TOP MONTESSORI SCHOOLFACILITY NUMBER:
093614550
ADMINISTRATOR:KIME, JILLFACILITY TYPE:
850
ADDRESS:6526 PONY EXPRESS TRAILTELEPHONE:
(530) 903-3106
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:30CENSUS: 24DATE:
05/26/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jill KimeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Personal Rights - Child left unattended

Sanitation- Facility unsanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michelle Pascual met with Director, Jill Kime to deliver findings for the above allegations, via tele-inspection via Face time (due to COVID-19).
The current census was 24 children, two fully qualified teachers and 1 aid.
According to the complaint a “child left unattended,” was investigated through interviews with six (6) teachers, in addition to the Director. The Director admitted to a child wandering away and into the facilities parking lot. The child was returned by a stranger. This allegation was also corroborated with four (4) other teachers, who witnessed the incident taking place.
The allegation of “facility unsanitary” was also investigated with interviews of six (6) teachers and twelve (12) children. Of those interviewed four (4) of the six teachers and seven (7) of the twelve children corroborated the allegation. It was found that the dogs brought to the facility by the Director would defecate on the play yard ground, which would transfer to the children’s shoes, clothes & play yard equipment.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 03-CC-20210309150708
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: 05/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/27/2021
Section Cited
CCR
101229(a)(1)
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Absence of supervision- No child(ren) shall be left without the supervision of a teacher at any time. This requirement was not met as evidenced by the admission of the child wandering away per the Director and teachers.
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Director to write a letter explaining how she has corrected the lack of supervision issue. Director purchaed a gate to keep children inside the main room, will submit proof.
Type B
05/26/2021
Section Cited
CCR
101238(a)
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Sanitation- The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Director to explain with a written letter that she will no longer bring her dog to the facility, as this was her desire to avoid future issues.
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This requirement was not met as evidenced by interviews with children and staff witnessing feces on the play ground and play yard equipment.
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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 MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
03/09/2021 and conducted by Evaluator Michelle Pascual
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210309150708

FACILITY NAME:PINE TOP MONTESSORI SCHOOLFACILITY NUMBER:
093614550
ADMINISTRATOR:KIME, JILLFACILITY TYPE:
850
ADDRESS:6526 PONY EXPRESS TRAILTELEPHONE:
(530) 903-3106
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:30CENSUS: 24DATE:
05/26/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jill KimeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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7
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9
Personal Rights- Medication accessible to children

Personal Rights- Teacher handles children aggressively

Supervision- Out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Michelle Pascual met with Director Jill Kime to deliver findings for the above allegations via tele-inspection (Face Time). There were 24 children present, two fully qualified teachers and one assistant.

The complaint alleged the "facility out of ratio,” “medication was accessible to children” and “teacher handles children aggressively."
During the course of the investigation, LPA interviewed twelve (12) children and six (6) teachers in addition to the director. According to the complaint “facility out of ratio,” teachers would take children outside and leave an aid alone with children inside. During the interview process LPA could not corroborate this information with enough evidence. The allegation that “medication was accessible to children,” was also investigated. LPA found that although this may have taken place, there was not enough evidence in the interview process to corroborate allegation. The final allegation of “Teacher handles children aggressively” was investigated through interviews of staff and children. LPA found that although this may have taken place, there was not enough evidence to corroborate the allegation. Based on the information gathered throughout the course of this investigation there was not sufficient enough evidence nor information to support or dismiss the above allegations. Therefore, the findings for the above allegations are all determined to be UNSUBSTANTIATED. An exit interview was conducted in which the report was reviewed and discussed with the licensee
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20210309150708
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
VISIT DATE: 05/26/2021
NARRATIVE
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Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22 Division and Chapter number) are being cited on the attached LIC 9099-D.
A civil penalty will be assess under the Health & Safety Code 1596.99 (c)(3). This states
"Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age."

Citations are referenced in the 9099D.

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 licensee.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4