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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093620107
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:36:37 PM


Document Has Been Signed on 08/03/2022 01:36 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:LTUSD PRESCHOOL PROGRAMFACILITY NUMBER:
093620107
ADMINISTRATOR:LINDSTROM, AMYFACILITY TYPE:
850
ADDRESS:1100 LYONS AVENUETELEPHONE:
(530) 541-2850
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:21CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Annamarie CohenTIME COMPLETED:
01:50 PM
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At 10:30AM on Wednesday, August 3, 2022, Licensing Program Analysts (LPAs) Arianna Manabat and Mandie Goodwin and Licensing Program Manager (LPM) Natalie Dunaway met with Facility Representative, Annamarie Cohen, for the purpose of an announced case management - licensee initiated inspection. Licensee requests a room change. During today's visit there were no children in care. The facility's current hours of operation are Monday through Friday from 7 AM to 5 PM.

A health and safety inspection was conducted in all areas accessible to children. LPAs observed the facility had a sufficient amount of furniture, toys, and cubbies in the classrooms. LPAs advised that the tables and chairs should be suitable for preschool sized children.

The total square footage for the classroom P-2 is 725.32 sqft which will accommodate 20 preschool children.

LPAs observed the outdoor play area is fenced and equipped with a sufficient amount of play equipment and toys. The outdoor space measures 2,291 sqft which will accommodate 20 children. There is sufficient resilient material underneath climbing structures to absorb a fall.

Prior to licensor the following must be completed;
1. A revised fire clearance must be received for 20 children
2. A waiver submitted for sharing the outdoor playground for both licenses.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. Notice of Site was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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