093610400-5-10-2023-03-CC-SMAX-CRPQT8-20230510122642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093610400
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:26:51 PM

Document Has Been Signed on 05/10/2023 12:26 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	AL TAHOE SCHOOL HEAD START		FACILITY NUMBER:	093610400
ADMINISTRATOR:	GUTIERREZ, ROSA		FACILITY TYPE:	850
ADDRESS:	1100 LYONS AVE. #C5-8		TELEPHONE:	(530) 541-0284
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	103	CENSUS: 23	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Rosa Gutierrez		TIME COMPLETED:	12:30 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 May 10^th, 2023, Licensing Program Analysts (LPAs) Soleil Marx and Amanda Sutter. met with Director, Rosa Gutierrez, for an unannounced required annual inspection. LPA observed a census of 23 preschool age children being supervised by six staff. Facility hour of operation are Monday through Friday, 8:30AM to 3:00PM. All individuals subject to criminal record review have obtained clearance. LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment are in safe, operable condition. Playground equipment is in good repair and free of loose or sharp parts. LPA observed adequate cushioning in areas underneath climbing equipment and adequate shade provided. Toileting facilities are in safe, sanitary, and operating condition. Food preparation space is free of litter and all food protected against contamination. Menus are posted for AM/PM snack and lunch which is provided by facility. Drinking water is readily available to children both indoors and outdoors. Storage containers with solid waste have tight-fitting covers in each classroom. Medications are stored in a central location. LPA observed a functional carbon monoxide detector within the facility. LPA observed the facility utilizes full legal signatures on the sign in and out sheet. LPA observed required postings, children’s roster, and a fire/disaster drill log in which the last drill was conducted on 04/26/2023. LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification expiring 08/2024. Most staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. A sample of children’s files/records were reviewed, LPA observed that each child's file contained all the required documents. (1/2)

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: AL TAHOE SCHOOL HEAD START	FACILITY NUMBER: 093610400
	VISIT DATE: 05/10/2023

NARRATIVE

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Director was reminded that all adults 18 and older working in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA informed Facility Representative about Assembly Bill 2370, which will require certain licensed Child Care Facilities to test their water for excessive amounts of lead. This facility tested their water outlets for lead April 2018 and no exceedances were found. The facility is scheduled to re-test water outlets for lead exceedances in May 2023.

Incidental Medical Services (IMS) policy was discussed. The facility is currently providing IMS and has a plan of operation in place. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Title 22 deficiencies are being cited on 809-D.
This report was reviewed with Director, and an exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. (2/2)

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 05/10/2023 12:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: AL TAHOE SCHOOL HEAD START	FACILITY NUMBER: 093610400
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 staff did not have a complete file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2023
	Plan of Correction
1 2 3 4	Director will submit completed file of staff member to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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