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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293622663
Report Date: 02/22/2024
Date Signed: 03/14/2024 11:08:17 AM

Document Has Been Signed on 03/14/2024 11:08 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:IRON AND PINE PRESCHOOLFACILITY NUMBER:
293622663
ADMINISTRATOR:DIVINE, JESSICAFACILITY TYPE:
850
ADDRESS:215 WASHINGTON STTELEPHONE:
(530) 955-5214
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
02/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jessica DivineTIME COMPLETED:
12:30 PM
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*This report was originally drafted during a visit on 2/22/2024. On that day, computer issues prevented the collection of signatures and final printing. Visit conducted on 3/14/2024 to complete report.*

At 9:20am on 2/22/2024, Licensing Program Analyst (LPA) Matthew Gallo met with Director Jessica Divine to conduct a case management incident visit related to a self-reported unusual incident. Today's census included 8 preschool children.

The facility was notified by a parent on 2/21/2024 that their child (C1) had mentioned an incident of inappropriate touching of private parts by another enrolled child (C2) that occurred during outdoor play time the previous day, 2/20/2024. LPA reviewed records, observed the play yard, and conducted interviews with staff. LPA also interviewed one child who was old enough to converse. LPA determined that the inappropriate touching between children did occur on 2/20/2024. Staff interviews revealed that 2 staff members and an adult were providing outdoor supervision at the time. Information collected did not provide a preponderance of evidence to conclude that the incident was due to a lack of supervision. No Title 22 deficiencies are cited as a result of the incident.

Exit interview conducted and report was reviewed with director Jessica Divine. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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