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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620403
Report Date: 06/08/2022
Date Signed: 06/08/2022 02:14:28 PM


Document Has Been Signed on 06/08/2022 02:14 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:LIFE TIME ATHLETIC - ROSEVILLEFACILITY NUMBER:
313620403
ADMINISTRATOR:SHAUNA WOODSONFACILITY TYPE:
840
ADDRESS:1435 EAST ROSEVILLE PARKWAYTELEPHONE:
(916) 472-2051
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:150CENSUS: DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Emily ThompsonTIME COMPLETED:
02:30 PM
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On June 8th, 2022, at 12:00 pm, Licensing Program Analyst (LPA) Jeremey McClain met with Program Director Emily Thompson for an unannounced required annual random inspection. The school age program operates from May 31 – August 12 from 7 am to 6 pm, at the public Life Time Athletic gym.

During inspection, LPA observed 90 school aged children being supervised by 17 staff members.

LPA inspected all activity areas including basketball courts, tennis courts, locker rooms, bathrooms, outdoor turf areas, and indoor and outdoor pools. Facility has is operating with the specifications of the waiver for pool usage, and use of bathrooms that are also used by the public. Hazardous items are inaccessible. Furniture and equipment are in operable condition. Playground equipment and surfaces are free of loose or sharp parts, adequate cushioning was observed in the turf area, and adequate shade was observed in outdoor areas. 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 in each classroom. Medications are appropriately stored and inaccessible to children. LPA observed a functional carbon monoxide detector.

Meals are provided by the facility for families that wish to participate in the meal program. Families are also allowed to provide their own meals that do not require refrigeration. LPA observed posted menus showing planned meals at least one week in advance. Non contaminated drinking water is readily available to children both indoors and outdoors through drinking fountains and water bottles provided by children.The facility currently utilizes and electronic sign in and out sheet and has a written system in place for backup.

LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification which expires: 05/2024. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. (PAGE 1/2).

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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: LIFE TIME ATHLETIC - ROSEVILLE
FACILITY NUMBER: 313620403
VISIT DATE: 06/08/2022
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10 children records were reviewed. Each child's file contained a completed emergency contact form, immunization records, signed personal rights form, and a completed medical assessment.

Incidental Medical Services (IMS) policy was discussed. The facility is currently providing IMS and has a plan of operation in place. 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 encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations, and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.

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.

This report was reviewed with licensee, and an exit interview was conducted.



A Notice of Site Visit was provided and should remain posted for 30 days. (PAGE 2/2)
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
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