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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622152
Report Date: 04/05/2024
Date Signed: 04/05/2024 11:10:17 AM


Document Has Been Signed on 04/05/2024 11:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:LITTLE SUNSHINE'S PLAYHOUSE & PS - GRANITE BAYFACILITY NUMBER:
313622152
ADMINISTRATOR:MARCI PILGRIMFACILITY TYPE:
830
ADDRESS:5370 DOUGLAS BLVDTELEPHONE:
(916) 605-0217
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:48CENSUS: 28DATE:
04/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Marci PilgrimTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Jeremey McClain met with facility representative Marci Pilgrim for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPA observed 28 infants and toddlers supervised by 9 staff in separate rooms.

It was reported that on March 28, 2024, a child in care suffered an allergic reaction. Staff believed the child was suffering a mild reaction at the time, and administered medication based on the medication plan and the parent’s instruction. Once the parent arrived, they determined the reaction was more severe, and administered an epinephrine pen and took the child to the emergency room. The child has since returned to care. The facility took steps to remove play dough and bird seed, which is believed to have caused the reaction.

During today’s inspection, LPA interviewed staff that were supervising and attending to the child. LPA reviewed doctor’s instructions and the Incidental Medical Services plan. LPA discussed a plan with staff to help determine a mild reaction versus severe reaction for all children with allergies. LPA determined that the incident was not due to lack of care or neglect on the facilities part.

An exit interview was conducted with facility representative Marci Pilgrim. A Notice of Site Visit was provided which shall remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
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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