<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 290317246
Report Date: 11/14/2022
Date Signed: 11/14/2022 04:09:43 PM


Document Has Been Signed on 11/14/2022 04:09 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:TAHOE FOREST CHILDREN'S CENTER-SCHOOL AGEFACILITY NUMBER:
290317246
ADMINISTRATOR:SHURTLEFF, MARILYN REBEKAHFACILITY TYPE:
840
ADDRESS:10121 PINE AVENUETELEPHONE:
(530) 582-3572
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY:15CENSUS: 6DATE:
11/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Marilyn Rebekah ShurtleffTIME COMPLETED:
04:30 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
Licensing Program Analyst (LPA) Amanda Blesi arrived to the facility and met with director, Rebekah Shurtleff for the 1-year required annual inspection. Upon arrival at 12:45 PM, there were no school age children present. During the inspection, six school age children arrived.

LPA toured the classroom, restroom, and outdoor play area. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The floors appeared clean throughout the facility. All food was protected against contamination. Children bring their own snacks and staff were reminded to have extra snacks available in case needed. Drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector.

Staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA reviewed the Department's inspection authority and discussed 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.

Facility representative was reminded that all adults 18 and over, 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 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.



Report continued on 809-C.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: TAHOE FOREST CHILDREN'S CENTER-SCHOOL AGE
FACILITY NUMBER: 290317246
VISIT DATE: 11/14/2022
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
26
27
28
29
30
31
32
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. 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 discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

There were no Title 22 Deficiencies cited during today's inspection.

Exit interview conducted and report was reviewed with the facility representative Rebekah Shurtleff.


A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2