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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090312340
Report Date: 07/09/2024
Date Signed: 07/09/2024 11:47:21 AM

Document Has Been Signed on 07/09/2024 11:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EL DORADO COUNTY SENIOR DAY CARE CENTERFACILITY NUMBER:
090312340
ADMINISTRATOR/
DIRECTOR:		WILSON, NANCYFACILITY TYPE:
775
ADDRESS:935-A SPRING STREETTELEPHONE:
(530) 621-6180
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 60CENSUS: 3DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator Nancy WilsonTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 7/9/2024 Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to conduct an annual visit. LPA met with Administrator Nancy Wilson and explained the purpose of the visit.

LPA and Administrator toured facility together to ensure health and safety of clients in care. Areas toured include but are not limited to: bathrooms, classrooms, hallways, kitchen and outside grounds.. LPA reviewed 5 client files and 2 staff files. All files contained the required paperwork. Water temperature was within the required temperature range. First Aid kit was fully stocked. All medications, cleaning chemicals and laundry supplies were kept locked.

Administrator agreed to send updated LIC500 and LIC610 to CCLD by end of month.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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