313620403-8-1-2019-03-CC-JMCN-BEMJ42-20190801064223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313620403
Report Date: 07/30/2019
Date Signed: 08/01/2019 06:42:27 AM

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:	LIFE TIME ATHLETIC - ROSEVILLE		FACILITY NUMBER:	313620403
ADMINISTRATOR:	JOSHUA BALLY		FACILITY TYPE:	840
ADDRESS:	1435 EAST ROSEVILLE PARKWAY		TELEPHONE:	(916) 472-2000
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	150	CENSUS: 91	DATE:	07/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Shauna Woodson		TIME COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Jeremey McClain met with Director Shauna Woodson for an unannounced annual random inspection.

During today’s inspection, LPA observed 91 school-age children supervised by 13 staff members. Facility hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.

LPA toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are appropriately stored and inaccessible to children. No poisons were observed on the premises. 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. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides two snacks and lunch that is provided by the cafe. Children also have the option to bring their own lunches. Menus were posted and drinking water was readily available to children both indoors and outdoors. The facility utilizes and electronic sign in and sign out system and has a manual form for back up. The facility has indoor/outdoor pool areas that are shared with common members of the gym. The program currently has a waiver for the shared pool use, and the conditions are being adhered to.

Staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification which expires 06/03/2020. All staff currently employed with the facility has a criminal record clearance, health screening report, AB 1207 Mandated Reporter training certificates, and documentation of their educational background, training, and/or experience.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019

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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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: LIFE TIME ATHLETIC - ROSEVILLE	FACILITY NUMBER: 313620403
	VISIT DATE: 07/30/2019

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Incidental Medical Services (IMS) policy was discussed. The facility currently has children enrolled that require IMS. LPA provided and example of the plan of operation that must be submitted to the department. 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 verified the annual fees are current.

Director 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 child care centers.

This facility evaluation report was reviewed and discussed with Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019

LIC809 (FAS) - (06/04)

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