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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550320726
Report Date: 12/15/2020
Date Signed: 01/08/2021 09:33:28 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:MOTHER LODE CHRISTIAN SCHOOLFACILITY NUMBER:
550320726
ADMINISTRATOR:HART, STEPHANIEFACILITY TYPE:
850
ADDRESS:18393 GARDNER AVETELEPHONE:
(209) 928-1916
CITY:TUOLUMNESTATE: CAZIP CODE:
95379
CAPACITY:45CENSUS: 0DATE:
12/15/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Stephanie HartTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Justin Denton met with Director Stephanie Hart for a case management inspection. The center consists of three classrooms with a capacity of 45 children. This meeting was conducted virtually due to the ongoing COVID-19 pandemic.

Director Hart is converting a storage area to a "sick room" for children who aren't feeling well. At the moment, the center is using a classroom as a sick room, but would like to use that room as a classroom to function at the approved capacity of 45. Director Hart said that a teacher will be present whenever a child in the sick room and a "half-wall" will allow visibility of the room.

LPA toured "sick-room" virtually and observed it to be free of hazards. Director Hart said that two shelves will be removed to "open up" the room. The construction will occur while the center is closed for the break and is scheduled to be completed by January 5th, 2021. LPA advised Director to submit an updated Facility Sketch.

Exit interview conducted and appeal rights provided by email.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020
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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