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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 292701027
Report Date: 04/24/2023
Date Signed: 04/25/2023 08:39:52 AM

Document Has Been Signed on 04/25/2023 08:39 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:TAHOE ABILITY PROGRAMFACILITY NUMBER:
292701027
ADMINISTRATOR:WHITINGTON,KIMBERLYFACILITY TYPE:
775
ADDRESS:11025 PIONEER TRAILTELEPHONE:
(417) 619-0713
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY: 30CENSUS: 14DATE:
04/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kimberly WhitingTIME COMPLETED:
03:30 PM
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On 4/24/2023 LPA Tryon visited the program to do an annual visit using the CARE Tool.
LPA met with Kimberly Whitington, Director. LPA toured the program site with Ms. Whitington including classroom areas, kitchen, bathrooms, storage, office space. The program appears to be in nice condition, clean and well-furnished. The program has smoke detector/alarm/sprinkler system and fire extinguishers. Carbon monoxide detector installed. Participants bring their own lunch to program. There is refrigeration space, stove, sink, etc. available.
The facility maintains client and staff files in the program, which include required information.

LPA reviewed the Day Program version of the CARE Tool with Ms. Whitington..

At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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