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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623318
Report Date: 01/03/2022
Date Signed: 01/03/2022 10:25:59 AM

Document Has Been Signed on 01/03/2022 10:25 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LILY PAD EARLY LEARNING CENTER, INC.FACILITY NUMBER:
313623318
ADMINISTRATOR:ZEMLICKA, MICHELLEFACILITY TYPE:
850
ADDRESS:1388 LINCOLN WAYTELEPHONE:
(530) 863-9443
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 33TOTAL ENROLLED CHILDREN: 33CENSUS: DATE:
01/03/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Michelle Zemlicka - Director TIME COMPLETED:
10:45 AM
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Due to current Covid-19 protocols and Dept. of Public Health guidelines, the visit is being conducted via Zoom.

On Monday, January 3rd, 2022, at 10:00am, Licensing Program Manager (LPM) Keven Peters and Licensing Program Analyst (LPA) Blake Morillas met with Director, Michelle Zemlicka, via Zoom for an Informal Tele-visit.

LPM defined the difference between Non-Compliance and an Informal meeting. LPM advised that the purpose of today's meeting is to help provider gain compliance.

Today's informal meeting was to discuss the Type B citation issued on 12-6-2021.

LPM discussed current COVID-19 protocols, departmental enforcement, and PPE usage at the facility.

This report (LIC 809) and Appeal Rights (LIC 9058) will be delivered to the Director electronically via email. Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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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