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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622153
Report Date: 12/06/2022
Date Signed: 12/06/2022 12:31:38 PM

Document Has Been Signed on 12/06/2022 12:31 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:LITTLE SUNSHINE'S PLAYHOUSE & PS - GRANITE BAYFACILITY NUMBER:
313622153
ADMINISTRATOR:MARCI PILGRIMFACILITY TYPE:
850
ADDRESS:5370 DOUGLAS BLVDTELEPHONE:
(916) 605-0217
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 56DATE:
12/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Marci PilgrmTIME COMPLETED:
12:30 PM
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On December 6th, 2022, Licensing Program Analysts (LPAs) Jeremey McClain and Katrina Owens met with Licensing Representative Marci Pilgrim for an unannounced Case Management Inspection regarding an Unusual Incident Reported.

LPAs observed care and supervision of 56 preschool children by 8 staff between four classrooms.

On November 23rd, 2022, it was reported that a child hit their head on a plastic picnic table on the playground. The child was treated with ice and parents were notified. The child was later taken to urgent care and was cleared to return care the following day. During today’s inspection, LPA made observations to the playground and equipment. LPA spoke with staff regarding the incident.

LPA determined that the incident was not due to lack of supervision or hazards on the playground. No deficiencies were observed.

This report was reviewed with the Licensing Representative. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
Keven Peters
Jeremey McClain
DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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