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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093620107
Report Date: 11/18/2019
Date Signed: 11/18/2019 02:31:37 PM

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:TAHOE VALLEY STATE PRESCHOOLFACILITY NUMBER:
093620107
ADMINISTRATOR:LINDSTROM, AMYFACILITY TYPE:
850
ADDRESS:1100 LYONS AVENUETELEPHONE:
(530) 541-2850
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:21CENSUS: 9DATE:
11/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Tara VohsTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Kristal Goodell met staff member Tara Vohs for an unannounced Annual Inspection. The Facility’s hours of operation are Monday- Friday, 7:15am- 5:15pm in addition to The program operates through the South Lake Tahoe Unified School District (LTUSD). Staff members present during inspection have been fingerprint cleared through LTUSD.

LPA toured the facility classroom C7 and restrooms. During inspection, LPA observed 9 children with two staff members. Staff stated breakfast and lunch are prepared off-site by the XX, Facility also provides afternoon snack. Lunch provided by parents or purchased upon request. LPA observed a current menu and activity schedule posted in classroom. LPA also observed the outdoor activity space and playground equipment. LPA observed cleaning compounds are inaccessible to children. LPA observed fire extinguisher 2A10BC, smoke detector and carbon monoxide. LPA observed fire drill log and children roster. LPA reviewed children’s files. LPA also reviewed staff files and educational background/transcripts. LPA observed that staff member present with the most current Pediatric CPR/First Aid expired on 2/10/20. Community Care Licensing website www.ccld.ca.gov, was provided so the facility can obtain updated licensing information, new regulations, self-assessment guides, and access forms. LPA advised the facility of their responsibility to stay current in regards to new regulations.

No Title 22 Deficiency cited. Report was reviewed. Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2019
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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