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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293622663
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:48:36 AM

Document Has Been Signed on 02/18/2022 11:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
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: DATE:
02/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
12:15 PM
NARRATIVE
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On Friday, February 18th, 2022, at 10:03am, Licensing Program Analyst (LPA) Blake Morillas conducted a unannounced Case Management visit in regards to a received, self reported Unusual Incident Report (UIR). LPA informed the Director, Jessica Divine, of the reason for the inspection. At 10:04am, LPA observed 11 preschool children present along with 3 staff and 2 parent volunteers.

On 2-4-2022, the Director self reported an incident that occurred that same day (2/4) where a child had sustained a scratch that was caused by another child in care. Although the injury was minor and did not require medical attention, the age of the child who sustained the starch was noted to be under the age of 2 years old, which is in violation of the terms of their Preschool License (which allows care for children from ages 2 years old to entry into Kindergarten. Under special circumstances a exception may be issued on a case by case basis). When this was brought to the attention of the Director, they freely admitted they were under a misunderstanding of the age range they were able to care for and immediately terminated the child from care. Even though the Director took immediate action to correct the situation, a citation will be issued.

LPA B. Morillas informed Director, Jessica Divine, that this report, dated 2-18-2022, document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA B. Morillas informed the Director, Jessica Divine to provide a copy of this licensing report dated 2-18-2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director, Jessica Divine.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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Document Has Been Signed on 02/18/2022 11:48 AM - It Cannot Be Edited


Created By: Blake Morillas On 02/18/2022 at 11:09 AM
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: 02/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/18/2022
Section Cited
CCR
101161(a)

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Limitations on Capacity
101161(a): A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
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*Citation Cleared at time of visit*
When the Director became aware of the situation, they immediately terminated the child from care which brought the facility into compliance.
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This requirement is not met as evidence by the Director self reporting an incident where the child noted in the report was under the age that their license is designated for.
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The Director was reminded that their Preschool License allows for care of children ages 2 years old to entry into Kindergarten. Under special circumstances, an exception may be issued on a case by case basis.

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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: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022


LIC809 (FAS) - (06/04)
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