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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620403
Report Date: 09/14/2020
Date Signed: 09/16/2020 09:02:16 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 - ROSEVILLEFACILITY NUMBER:
313620403
ADMINISTRATOR:SHAUNA WOODSONFACILITY TYPE:
840
ADDRESS:1435 EAST ROSEVILLE PARKWAYTELEPHONE:
(916) 472-2000
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:150CENSUS: 0DATE:
09/14/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shauna WoodsonTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jeremey McClain conducted a Licensee Intitiated Case Management via Facetime with Director Shauna Woodson. The inspection was conducted via Facetime due to Covid-19. The facility has requested the addition of three rooms: Group Fitness Room1, Group Fitness room 2, and another Smaller Fitness Room. No changes have been made to the facility’s capacity or other licensed areas. In addition to the rooms, bathrooms were also added totaling four toilets, two urinals and four sinks.


INDOOR ACTIVITY SPACE:
The rooms are equipped with appropriate furnishings. The three additional rooms were measured at 5,262.12 square feet. The measured space will accommodate the current capacity. First Aid Kits and water will remain accessible to children when these areas are used. A fire clearance was granted on 09/08/2020.

LPA discussed cohort guidance as it relates to Covid-19 as well as supervision. As of today, the additional rooms have been approved for use.



A copy of the report was provided via email for review and signature.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020
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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