034500913-8-2-2023-53-CC-ASIS-CUBRDR-20230802125622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 034500913
Report Date: 08/02/2023
Date Signed: 08/02/2023 12:56:30 PM

Document Has Been Signed on 08/02/2023 12:56 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MOTHER LODE MOUNTAIN TOTS PRESCHOOL		FACILITY NUMBER:	034500913
ADMINISTRATOR:	ERICA MILLER		FACILITY TYPE:	850
ADDRESS:	23714 STATE HIGHWAY 88		TELEPHONE:	(209) 457-0995
CITY:	PIONEER	STATE: CA	ZIP CODE:	95666
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 12	CENSUS: 9	DATE:	08/02/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Erica Miller		TIME COMPLETED:	11:45 AM

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	Application Specialist (AS) Alecia Sifuentes met with Applicant Erica Miller for the purpose of an announced pre-licensing change of ownership inspection. Applicant requests a preschool license to serve 45 preschool children from age two to entry into first grade. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. The facility will not be providing meals. Parents are required to bring morning/afternoon snack and lunch for their child. AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. INDOOR ACTIVITY SPACE: There are five preschool classrooms and a napping area. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit located in the storage cupboard in classroom #1. Medications will be stored in the kitchen in a locked box or in the refrigerator if needed. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated staff will use a water pitcher and cups for the children indoors and outdoors. AS observed a functional carbon monoxide detector in classroom #1. AS observed a paper sign-in/sign-out system. AS measured five classrooms and napping area. The total classroom space contains a total of 2,117 square feet, which will accommodate Applicant's request for 45 preschool children. There are three toilets and one urinal and four sinks for the children, and a separate private restroom for the staff located in classroom #5. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in classroom #3 and will use the staff restroom, if necessary. Report continues on LIC809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE MOUNTAIN TOTS PRESCHOOL	FACILITY NUMBER: 034500913
	VISIT DATE: 08/02/2023

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on the property, yard #1 and yard #2. The outdoor play areas are fenced with a chain link fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There is one small and one middle play structure. Both play structures are approved for ages two years and above. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

AS measured yard #1 and yard #2. The outdoor play area contains a total of 5,212 square feet, which will accommodate Applicant's request for 45 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant 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.

Report continues on LIC809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE MOUNTAIN TOTS PRESCHOOL	FACILITY NUMBER: 034500913
	VISIT DATE: 08/02/2023

NARRATIVE

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Applicant 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 platform. 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.

Exit interview conducted and report was reviewed with the Applicant, Erica Miller.

The following items are required before a license will be issued:
1. Pending documents listed on LIC184
2. Final file review from Licensing Program Manager (LPM)
3. Granted Fire Clearance (STD850)

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

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