293622663-9-17-2021-03-CC-BMOS-C6XR3Z-20210917124047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293622663
Report Date: 09/17/2021
Date Signed: 09/17/2021 12:41:04 PM

Document Has Been Signed on 09/17/2021 12:41 PM - It Cannot Be Edited

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:	IRON AND PINE PRESCHOOL		FACILITY NUMBER:	293622663
ADMINISTRATOR:	DIVINE, JESSICA		FACILITY TYPE:	850
ADDRESS:	215 WASHINGTON ST		TELEPHONE:	(530) 955-5214
CITY:	NEVADA CITY	STATE: CA	ZIP CODE:	95959
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 13	DATE:	09/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jessica Divine - Director		TIME COMPLETED:	01:00 PM

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	On Friday, September 17th, 2021, at 10:35am, Licensing Program Analyst (LPA) Blake Morillas met with the Director, Jessica Divine, for the purpose of an unannounced Annual Required inspection. At 10:36am, 13 preschool age children and 3 staff were observed. Operating hours are 8:30am to 3:00pm, Monday through Friday. The facility operates year around. At 10:37am, LPA initiated a health and safety inspection of all indoor and outdoor areas accessible to the children in care LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA inspected the food service area and observed that the food products appeared to be protected against contamination. LPA reviewed care and supervision of children, staffing ratios, health related services (including medications and first aid supplies), furniture, equipment, and fire drills logs. LPA observed all required forms to be posted. Sign/in-sign/out sheet were reviewed. Drinking water is readily accessible to children in care. Water bottles are used when the children are outside. Outdoor play equipment appeared to be in safe condition. Shaded areas are also available. There are adequate toys, equipment, and supplies available for the children both inside and outside of the facility. LPA observed sinks and toilets to be operable. *Continued on LIC 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: IRON AND PINE PRESCHOOL	FACILITY NUMBER: 293622663
	VISIT DATE: 09/17/2021

NARRATIVE

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*Continuation of LIC 809

At 11:08am, LPA began to review children’s and staff's files. The Director stated that they are in the process of digitizing children's files. Both digital and physical files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid.

LPA provided and discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370).

LPA provided the Licensing Agency website (ccld.ca.gov), so the Director may obtain updated licensing information, regulations, and forms.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at 800-514-0301 (voice) (800-514-0383 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

Deficiencies are cited on the subsequent page of this report (LIS 809-D) under the California Code of Regulations, Title 22 of the California Health and Safety Code.

At 12:35pm, LPA reviewed the report with the Director and an exit interview was conducted.

LPA provided a Notice of Site Visit and the Director acknowledges that this notice shall remain posted for 30 days for parental review. The Director was provided a copy of the Appeal Rights (LIC9058).

The Director's signature on this form acknowledges receipt of this form.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/17/2021 12:41 PM - It Cannot Be Edited

Created By: Blake Morillas On 09/17/2021 at 12:12 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: IRON AND PINE PRESCHOOL	FACILITY NUMBER: 293622663
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2021 Section Cited CCR 101221(a)	1 2 3 4 5 6 7	101221: Child's Records: (a) A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by the children's files being incomplete during inspection. The Facility is in the process of digitizing files. When reviewing digital	1 2 3 4 5 6 7	The Director stated that they will work with parents to obtain all required documentation for the children's files by the POC due date.
	8 9 10 11 12 13 14	files, forms where found to be without signatures and/or overall incomplete. Physical files were also reviewed and found to be missing required documents such as the LIC 613A and physician signed immunization exemption forms. This is a potential 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:

Keven Peters

LICENSING EVALUATOR NAME:

Blake Morillas

LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC809 (FAS) - (06/04)

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