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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626834
Report Date: 04/28/2026
Date Signed: 04/28/2026 02:55:30 PM

Document Has Been Signed on 04/28/2026 02:55 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PRISTINE CHILDREN'S LEARNING ACADEMYFACILITY NUMBER:
343626834
ADMINISTRATOR/
DIRECTOR:		TURNER, SHANNONFACILITY TYPE:
860
ADDRESS:4650 MACK ROAD, UNIT #8TELEPHONE:
(916) 627-6040
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 9DATE:
04/28/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Shannon TurnerTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On April 28, 2026 at approximately 9:30 AM, Licensing Program Analyst (LPA), Josiah Gathing met with Licensee Representative (LR) Shannon Turner for an announced Case Management inspection to add Infant and School-Age components. Applicant is requesting a license for 20 infants (ages 6 weeks to 24 months) in the Duckies and Elephants rooms; 30 Toddlers (ages 18 to 36 months) in the Koalas, Bears, and Pandas rooms; 25 Preschool children (ages 2 to 5 years) in the Lions and Giraffes rooms; and 10 School-Age children (ages 5-12 years) in the Flamingos room. The total requested capacity is 85 children. Licensee previously requested capacity of 30 preschool children, but submitted a new application for 25 preschool children due to limited square footage. Hours of operation are Monday through Friday, 6:30 AM to 6:30 PM.

LPA measured total indoor infant activity space of 1,726.15 square feet, which is sufficient to accommodate the requested capacity of 20 infants. LPA measured total indoor School-Age activity space of 391.38 square feet, which is sufficient to accommodate the requested capacity of 10 School-Age children.

The remaining indoor activity space was previously measured during a pre-licensing inspection conducted on March 24, 2026. The Flamingos room was previously licensed for supervision of Preschool children, but is now being licensed for School-Age children. Due to the reduction in square footage, the Preschool indoor space will now accommodate a maximum of 25 children.


Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRISTINE CHILDREN'S LEARNING ACADEMY
FACILITY NUMBER: 343626834
VISIT DATE: 04/28/2026
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LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, cots, cribs, bookshelves, and other activity supplies for the children. Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via individual containers provided by parents. Additional cups are available in the facility. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. The fire department provided an approved fire clearance form to Licensing for 90 children on 2/25/2026. LPA submitted an updated fire clearance request for 85 total children during today's inspection.

LPA observed an infant changing table, in the Duckies room. Changing table has at least 1” padding covered with moisture-resistant, washable material. Sides of the changing table are at least 3” high. There is a sink within arm's reach of the changing table. Diapering sinks are not used for meal preparation or dishwashing. The infant napping area is physically separated from the indoor activity space according to regulation. During today's inspection, there were nine assembled cribs meeting regulatory requirements in the infant napping area. LPA observed additional cribs which were not set up in the infant nap area. LPA advised LR that the number of infants enrolled who require cribs must never exceed the number of available cribs in the nap area. Sleep Logs are kept in the infant classroom.

LPA observed a private restroom with a toilet and sink to be used by School-Age children. The remaining seven toddler toilets, seven toddler sinks, two preschool toilets, and two preschool sinks are sufficient to accommodate the remaining capacity.

The facility has two fully fenced playground areas. Fencing is at least four feet high. LPA measured total square footage of 2,802.47 for the outdoor infant activity space, which is sufficient to accommodate the requested capacity of 20 infants. The total square footage for the outdoor Toddler, Preschool, and School-Age playground is 2,533.88 which is sufficient to accommodate each component separately. A waiver for Toddlers, Preschoolers, and School-Age children to share the playground at different times shall be approved prior to licensure. Shade is provided via trees and the building.

There are sufficient outdoor toys and play equipment available on the playgrounds. LPA reminded LR to ensure that all play equipment and structures are only utilized by appropriate age groups. Drinking water is available outdoors via children's individual containers. There is also a sink available outdoors for refills.
Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRISTINE CHILDREN'S LEARNING ACADEMY
FACILITY NUMBER: 343626834
VISIT DATE: 04/28/2026
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LR was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LR was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child

LR was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.


Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRISTINE CHILDREN'S LEARNING ACADEMY
FACILITY NUMBER: 343626834
VISIT DATE: 04/28/2026
NARRATIVE
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Exit interview conducted and report was reviewed with LR, Shannon Turner.

The following corrections are needed prior to the issuance of the license:

-Waiver review and approval for shared toddler, preschool, and school-age outdoor activity space.


-Final review and approval by Licensing Program Manager.

LR understands that all proof of corrections must be provided to the department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
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