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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 292701043
Report Date: 08/01/2022
Date Signed: 08/30/2022 02:20:49 PM

Document Has Been Signed on 08/30/2022 02:20 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ELEVATION TRUCKEEFACILITY NUMBER:
292701043
ADMINISTRATOR:BANKERT, JEANNE MFACILITY TYPE:
775
ADDRESS:10344 & 10356 DONNER PASS RD.TELEPHONE:
(530) 386-0890
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY: 30CENSUS: 14DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:34 PM
MET WITH:Mandy Lis, Program ManagerTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Williams arrived at the facility unannounced on 08/01/2022 to conduct a Required 1- Year Inspection utilizing the infection control domain. LPA met with Program Manager Mandy Lis and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA was not screened upon entering the facility.

LPA and staff toured facility together to ensure health and safety of participants. Areas toured include but are not limited to: kitchen, lunch room, computer room, art rooms, sensory room, art store, and three (3) bathrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Program Director completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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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