<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093623233
Report Date: 02/25/2022
Date Signed: 02/25/2022 04:37:06 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
12/01/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20211201114710
FACILITY NAME:PINE TOP INFANT & TODDLER CTR (INF)FACILITY NUMBER:
093623233
ADMINISTRATOR:JILL KIMEFACILITY TYPE:
830
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 644-1317
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:18CENSUS: 7DATE:
02/25/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Syndi CableTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unqualified staff are supervising children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kelly Ferrara and Arianna Manabat conducted a complaint follow up inspection to deliver findings and met with Director Syndi Cable. LPAs observed there were currently seven children in care with three staff. During the investigation, LPA Ferrara interviewed Owner, Reporting Party, and six witnesses.

It was alleged that unqualified staff were taking care of the children. LPAs reviewed staff files and observed that one staff did not have all of the required coursework in order to be considered a qualified teacher. Owner stated that this staff has been utilized as a floating teacher and has been left alone with the children.
Based on the evidence obtained, LPAs determined that the allegation is substantiated, meaning the preponderance of evidence standard has been met. Exit interview was conducted and a copy of this report was given to the Director. Notice of Site was provided which must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
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 5
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
12/01/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20211201114710

FACILITY NAME:PINE TOP INFANT & TODDLER CTR (INF)FACILITY NUMBER:
093623233
ADMINISTRATOR:JILL KIMEFACILITY TYPE:
830
ADDRESS:5723 PONY EXPRESS COURTTELEPHONE:
(530) 644-1317
CITY:POLLOCK PINESSTATE: CAZIP CODE:
95726
CAPACITY:18CENSUS: 7DATE:
02/25/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Syndi CableTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is operating over ratio
Staff conduct poses a risk to children in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kelly Ferrara and Arianna Manabat conducted a complaint follow up inspection to deliver findings and met with Director Syndi Cable. LPAs observed there were currently seven children in care with three staff. During the investigation, LPA Ferrara interviewed Owner, Reporting Party, and six witnesses.
It was alleged that the facility was over ratio at times with eight to ten children alone with one teacher. Consistent statements were made during interviews that the facility has been following the 1:4 ratio and there were rarely over six to eight children in the classroom with two staff. However, LPA was not able to verify if the classroom was compliant with ratio, due to the facility not using classroom count sheets. Owner was not able to provide the appropriate documentation to prove the classroom was in ratio.
It was alleged that a staff person at the facility would come to work smelling like alcohol and had behavior that seemed inappropriate when working with children. Some witnesses stated they had observed this staff talking about drinking and partying in front of the kids and parents which did not feel appropriate.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 03-CC-20211201114710
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 INFANT & TODDLER CTR (INF)
FACILITY NUMBER: 093623233
VISIT DATE: 02/25/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Inconsistent statements were made regarding whether the staff left a child alone or with an aide to walk through the hallway. All interviews confirmed this staff no longer works at the facility.

Based on the evidence obtained, LPAs determined that the allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove it. Exit interview was conducted and a copy of this report was given to the Director. Notice of Site was provided which must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 03-CC-20211201114710
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 INFANT & TODDLER CTR (INF)
FACILITY NUMBER: 093623233
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2022
Section Cited
CCR
101416.2(c)(1)(A)
1
2
3
4
5
6
7
To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood… (A) At least three of the units…shall be related to the care of infants…
1
2
3
4
5
6
7
Director acknowledged that she understands the regulation and will not leave unqualified staff alone with children. Director shall submit a staff schedule and the staff's proof of ECE course enrollment to LPAs by POC due date.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: LPAs learned that staff was being left alone with children and was not a qualified infant teacher based on record review. This is an immediate health and safety risk to 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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 03-CC-20211201114710
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 INFANT & TODDLER CTR (INF)
FACILITY NUMBER: 093623233
VISIT DATE: 02/25/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
One Type A deficiency was cited on the attached LIC 9099D. Upon receipt of a Type A citation, licensee shall post and provide copies of the LIC 9099 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099 D in each child's file.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5