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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093614550
Report Date: 06/10/2021
Date Signed: 06/10/2021 03:32:43 PM

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: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: DATE:
06/10/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jill KimeTIME COMPLETED:
10:15 AM
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Licensing Program Manager (LPM) Maria Mayorga and Licensing Program Analyst (LPA) Michelle Pascual, met with the Director, Jill Kime for an Informal Office visit. LPM defined the difference between a non-compliance conference and an informal meeting. LPM advised that the purpose of today's meeting is to help the Licensee gain compliance. Today's informal meeting is to discuss Personal Rights Type A deficiencies that were cited on 5/26/2021 & 4/27/2021. The citations issued were for the facility not ensuring the personal rights of children in care, facility unsanitary, child left unattended & reporting requirements.

Licensee stated that she would work with Community Care Licensing to stay in compliance, and that she has taken the following steps:
1. Personal Rights: The director has installed a gate that keeps the children contained to one room away from the door, so they cannot run out of the facility.
2. Reporting Requirements: Licensee acknowledges that an unusual incident must be reported to Licensing via telephone within 24-hours & written within 7-days.
3. Facility Unsanitary: Director understands that the play yard as well as the inside of the classroom must be clean and free of any feces left behind from the animals she has brought into the facility. Director no longer has animals at the facility and will refrain from bringing her own dogs to the facility.

During today's meeting, LPM discussed and reviewed personal rights with Licensee and reminded her to ensure that children’s personal rights are not violated during the operation of her child care center. LPM suggested that Director seek additional support from the Resource & Referral agency as well as the community college when looking to hire qualified teachers.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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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