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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622073
Report Date: 11/18/2019
Date Signed: 11/18/2019 03:44:47 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:LTUSD INFANT PROGRAMFACILITY NUMBER:
093622073
ADMINISTRATOR:WESSELL, BILLYFACILITY TYPE:
830
ADDRESS:1735 LAKE TAHOE BLVDTELEPHONE:
(530) 543-2350
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:10CENSUS: 4DATE:
11/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Goodell met with staff member Abigail Ruiz for an unannounced Annual Inspection. The facility's hours of operation are Monday- Friday, 7am- 5:30pm and follow the LTUSD academic calendar. During inspection LPA observed 4 children present with 2 staff members. All individuals present have obtained fingerprint clearance through the staff have obtained fingerprint clearance through the school district.

LPA toured the classroom 4, furniture, equipment, and restrooms. The Director stated that the facility provides breakfast, lunch and snack provided through school district. LPA observed a current menu posted in infant classroom. LPA observed cleaning compounds inaccessible to children. LPA observed that the changing tables are located near a sink. LPA observed the outdoor area and play equipment. LPA observed fire extinguisher 2A10BC, smoke detector and carbon monoxide detector. LPA reviewed children files; documents included Identification and Emergency information and the Infant’s Needs and Services plan. Staff stated all milk and food brought from home are returned daily. LPA observed the napping equipment. Staff acknowledged the nap area is separate from the activity area and direct supervision is required in both areas when children are present. LPA reviewed staff educational requirements and observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires 5/2020. LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms.

No Title 22 Deficiencies cited. LPA reviewed report with staff. Notice of Site Visit (LIC9213) issued and 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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