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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570312613
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:06:09 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:PIONEER SCHOOL AGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
570312613
ADMINISTRATOR:BREEZZIE NORRISFACILITY TYPE:
840
ADDRESS:5131 HAMEL STREETTELEPHONE:
(530) 758-0611
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:64CENSUS: 14DATE:
03/05/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Site Supervisor, Brezzie NorrisTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Chayntel Hunter and Amy Silva met with Site Supervisor, Brezzie Norris to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 03/03/2020. During today's visit the facility was toured. Present were 14 school age children in care and 4 staff.

LPAs interviewed the Site Supervisor who was present during the incident. LPAs reviewed and discussed this report with the Site Supervisor.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

Site Supervisor stated they are going to change their sign in/out policy, due to the incident that occurred. Through interviews conducted, LPAs learned that at the time of the incident C1 had not been signed into the facility. C1 was in the care of an employee of the school district. Facility provided LPA with written statement to prevent future occurrences.

Facility evaluation report was reviewed and discussed with Site Supervisor. Exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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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