093614550-11-8-2021-03-CC-MMAA-C8T2CH-20211115161645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093614550
Report Date: 11/08/2021
Date Signed: 11/08/2021 12:43:39 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
11/04/2021 and conducted by Evaluator Tanya Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20211104110053

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: 10	DATE:	11/08/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Carrie Malaug and Jill Kime		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Masks are not required.

There are yard hazards.

INVESTIGATION FINDINGS:

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On November 8, 2021 at 10:30 AM, Licensing Program Analyst Tanya Washington met with teacher Carrie Malaug regarding the allegations mentioned above. Upon arrival, two staff members and ten children were present at the facility. Director/ Owner Jill Kime arrived to the facility shortly after LPAs arrival, she assisted LPA with the remainder of the inspection.

It was alleged that children and staff are not wearing masks as mandated by Department of Health. Upon entry to the facility LPA did not observe staff or any children wearing masks. Staff stated that if the parents are not requiring their child to wear a mask they don't enforce mask wearing. Staff indicated that they wear their mask most of the time unless they are eating or drinking.
Continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

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-20211104110053

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: 11/08/2021

NARRATIVE

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LPA advised that the guidance states all individuals, including staff and parents (regardless of vaccination status), and children over two years old in any licensed facility must wear a mask unless eating, drinking, or napping.

Facility did have a supply of children's masks, hand sanitizer and a thermometer at the door. Director stated that she will notify all parents of the guidance.

It was also alleged that there is a hole with sharp edges with protruding wiring on the chicken coop where a child could potentially get hurt and the top of the chain link fence in the outdoor area is hanging down.
LPA observed that there is a hole in the wiring of the chicken coop, Director stated that the coop has not been used for a long time and they provide supervision to ensure that children do not go near that area. Director also stated that she has placed a work order for her fence to be repaired. She explained that they had a fire which partially burned the fencing and currently there is a safety net installed to prevent children from exiting the yard area. Director will submit proof of estimate for the fence repair along with the estimated time frame on when the work will be complete.

Based on the evidence obtained, the allegations are substantiated, meaning that the preponderance of evidence standard has been met. Exit interview was conducted and a copy of this report and Notice of Site was provided. Appeal rights are provided.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 03-CC-20211104110053

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: 11/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/22/2021 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	BUILDINGS AND GROUNDS: 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.	1 2 3 4 5 6 7	Director stated that the chicken coop will be removed and the work order for the fence replacement has been placed.
	8 9 10 11 12 13 14	This requirement is not met as evidenced: There is a hole with protruding wiring in the chicken coop where a child could potentially get hurt. The outdoor chain link fence is hanging down and a large portion is missing due to recent fire. This is potential risk to the health and safety of children in care.	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: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC9099 (FAS) - (06/04)

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