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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621616
Report Date: 06/03/2022
Date Signed: 06/03/2022 02:41:12 PM


Document Has Been Signed on 06/03/2022 02:41 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 - FOLSOMFACILITY NUMBER:
343621616
ADMINISTRATOR:CATE, JENNIFERFACILITY TYPE:
840
ADDRESS:110 HEALTHY WAYTELEPHONE:
(916) 597-9100
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:150CENSUS: 58DATE:
06/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Robbie AnzeldeTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Kelly Ferrara and Alize Tillery met with Director Robert Anzelde for the purpose of an unannounced annual inspection of Kids Summer Camp within the Life Time Athletic Club. LPAs observed there were currently 58 children in care with nine staff. There are two other child care programs on site that are exempt from Licensing. LPAs toured the areas of the facility that are licensed through Community Care Licensing which include: the Activities Studio, Kids Academy (Tumbling Studio, Language and Arts Studio, Kids Gym), Basketball Court, Education Center, Tennis Courts, Indoor Pool, and Outdoor Pool. LPAs were told that the Tween Room is no longer being used. The Summer Camp also uses the Tumbling Studio, Language/Arts Studio, Kids Gym and Activity Studio when not in use by the exempt child care on site. The program operates Monday - Friday from 7 AM to 6 PM. Lifetime Kids Camp children wear wrist bands while in care to distinguish them from the other programs. Director was reminded never to exceed the conditions, limitations and capacity specified on the license.

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.



The rooms used by the children all appeared clean including the carpets and floor. In the outdoor areas there are shade structures in place and children bring there own water bottles outside. There are multiple Carbon Monoxide detectors and smoke alarms located throughout the building. A menu is posted and lunch is provided by the parents or they have food available to them from the cafe on premises, and AM and PM snacks are available. Director stated that the camp is set up daily on the basketball court where the children eat lunch and parents sign the children in and out on an iPad. All cleaning supplies were stored inaccessible to children in care. Toileting facilities are in safe, sanitary, and operating condition and there is a waiver on file to use the restrooms that are also used by non camp members.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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 - FOLSOM
FACILITY NUMBER: 343621616
VISIT DATE: 06/03/2022
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There are two pools on site that the children use, one indoor and one outdoor. There are lifeguards on duty and staff are with the children at all times. There is a waiver on file for the pool area.

LPAs learned that the facility has a new Director who started in September 2021. LPA Ferrara did not receive a full director packet to review for qualifications and it was not available for review on site. A sample of staff files were reviewed. The files contained the appropriate documentation including Mandated Reporter certificates and proof of immunizations. LPAs advised that the Mandated Reporter certificate must be renewed every two years. There is at least one staff with a current CPR/1st aide certificate which expires August 2022. A sample of children's files were reviewed. LPAs observed all paperwork was present except for the Parent's Report (LIC702) in ten out of ten files reviewed.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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



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/inspection-process.

Facility Representative was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

Two type B citations were issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 06/03/2022 02:41 PM - It Cannot Be Edited

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 - FOLSOM

FACILITY NUMBER: 343621616

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101521(b)(1)

(b) The licensee shall obtain from the child's authorized representative a health background related to the child's ability/inability to participate in center activities. (1) A health background should include but not be limited to: (A) Past illnesses or serious injuries. (B) Allergies, including food allergies. (C) Conditions requiring special attention in the school-age child care center. (D) Special problems or fears.
This requirement is not met as evidenced by: LPAs did not observe an LIC 702 Parent's Report in any of the children's files.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in ten out of ten children's files which poses/posed a potential health, safety risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
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Director shall have all parents fill out an LIC 702 Parent's Report for each child enrolled. Director shall send a copy of ten children's documents to LPA Ferrara by POC due date.
Type B
Section Cited
CCR
101217(d)(1)
Personnel Records (d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, LPAs were not able to review a file for the new Director to determine Director qualifications which poses/posed a potential health, safety risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
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Director shall submit a completed Director packet to LPA Ferrara by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3