093623907-5-13-2021-03-CC-MPAL-C2YSB5-20210513134322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093623907
Report Date: 05/13/2021
Date Signed: 05/13/2021 01:44:55 PM

Document Has Been Signed on 05/13/2021 01:44 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:	LAKE TAHOE PRESCHOOL		FACILITY NUMBER:	093623907
ADMINISTRATOR:	TOUTOLMIN, STEFANIE		FACILITY TYPE:	850
ADDRESS:	2111 SOUTH AVENUE		TELEPHONE:	(530) 416-2324
CITY:	LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY: 49	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/13/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Stefani Toutolmin		TIME COMPLETED:	10:30 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	Licensing Program Analyst (LPA) Michelle Pascual and Licensing Program Manager (LPM) Seychelle De Luca met with Applicant Stefanie Toutolmin for the purpose of an announced prelicensing, location change tele-inspection (due to COVID-19). Applicant requests a preschool license to serve 49 preschool aged children. The current preschool is facility # 093621200. The program will operate Monday through Friday from 8:00 AM to 5:00 PM. The fire clearance was granted on 5/11/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. The facility will provide snacks and the children will bring lunch & drinks from home. INDOOR ACTIVITY SPACE: There are four classrooms. LPA and LPM discussed the equipment that is currently being moved from the prior school-aged facility and is in the process of being moved to the current facility. Applicant stated cleaning disinfectants and medications will be appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated children will bring water bottles. Applicant stated the carbon monoxide detector is hardwired into the system. LPA and LPM observed trash cans with lids. LPA and LPM observed a paper sign-in/sign-out system.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LAKE TAHOE PRESCHOOL	FACILITY NUMBER: 093623907
	VISIT DATE: 05/13/2021

NARRATIVE

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Applicant did not measure the four classrooms, as the measurements were used from the School Aged facility and transferred. The total classroom space contains a total of 1901 square feet, which accommodates Applicant's request for 49 children. There are three toilets and four sinks for the children. Two toilets and two sinks are located in Room 1. There is a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office and use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are three outdoor areas on the property. Applicant did not need to remeasure, as the measurements from the School Aged were utilized and transferred. The outdoor play area contains a total of 16725 square feet, which accommodates Applicant's updated request for 49 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). The climbing structure in the outdoor space near the parking lot has a safety label that reads it is intended for children 2 to 12 years of age. The climbing structure in the other outdoor space does not have a safety label. The outdoor play areas is fenced with a chain link fence that is at least four feet tall. LPA and LPM observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees. Applicant stated they will use water bottles.

The facility's Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. 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.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LAKE TAHOE PRESCHOOL	FACILITY NUMBER: 093623907
	VISIT DATE: 05/13/2021

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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 and LPM discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA 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.

This facility evaluation report was reviewed and discussed with Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

This facility evaluation report was reviewed and discussed with Applicants. LPA emailed a copy of the 809 to Applicants. Applicant understand they must read the reports and send back an acknowledgement that they read and received the report. LPA also emailed LIC311A, Effects of Lead Exposure brochure, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1: Director wishes to open facility effective June 1st 2021.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC809 (FAS) - (06/04)

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