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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623785
Report Date: 01/23/2024
Date Signed: 01/23/2024 03:08:35 PM

Document Has Been Signed on 01/23/2024 03:08 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LILY PAD EARLY LEARNING CENTERFACILITY NUMBER:
313623785
ADMINISTRATOR:THATCHER, STACIFACILITY TYPE:
850
ADDRESS:3330 CHISOM TRAILTELEPHONE:
(530) 863-9443
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 7DATE:
01/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Marlene Freed/EkstrandTIME COMPLETED:
03:30 PM
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On January 23, 2023 Licensing Program Analyst (LPA) Lea Habtom arrived at Lily Pad location in Loomis to open a complaint. LPA conducted a case management inspection with designated representative, Marlene Freed/Ekstrand. The purpose of this case management is to address fingerprint clearances/transfers for employees assisting or working at the facility. LPA reminded designated representative that all staff must obtain a criminal record clearance, exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. LPA record reviews and interviews provided evidence that three staff worked in the facility without having their clearance or documentation transferred to the facility. Owner, Michelle Zemlicka, arrived during the inspection to continue the report with LPA. Associations for two staff members were completed on 1/22/2024.

Based on today's inspection, one Type B deficiency is being cited on 809-D. Exit interview was conducted and this report was reviewed with designated representative Marlene Freed/Ekstrand and owner Michelle Zemlicka, has been provided with appeal rights and this report. Notice of Site was provided and must remain posted for 30 days.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2024
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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Document Has Been Signed on 01/23/2024 03:08 PM - It Cannot Be Edited


Created By: Lea Habtom On 01/23/2024 at 01:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LILY PAD EARLY LEARNING CENTER
FACILITY NUMBER: 313623785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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Deficiency was cleared when the owner, Michelle, had two staff member fingerprints associated on 1/22/2024.
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(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) This requirement was not met as evidenced by: 2 staff that were present at the facility and 1 that previously worked at the facility witithout a fingerprint transfer which poses a potential risk to health & safety of children.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024


LIC809 (FAS) - (06/04)
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