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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624592
Report Date: 11/08/2024
Date Signed: 11/08/2024 12:40:22 PM

Document Has Been Signed on 11/08/2024 12:40 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:HURST-LEWIS, REJANEFACILITY NUMBER:
313624592
ADMINISTRATOR/
DIRECTOR:		HURST-LEWIS, REJANE &FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 425-7711
CITY:TAHOE CITYSTATE: CAZIP CODE:
96145
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Rejane Hurst- LewisTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 11/8/2024, at approximately 10AM, Licensing Program Analyst (LPA), Michelle Perez, met with licensee, Rejane Hurst- Lewis. Spouse was present. LPA observed 4 children. Two preschool aged and two infants. Infants were napping at time of arrival.

The purpose of the visit was in response to an unusual incident report that involved two day care children that escaped from the rear yard deck, and went missing resulting in an absence of supervision.

The two children were left unattended for a short period of time, while the licensee went inside to change the diapers of the two infant children. While inside, the licensee realized there was no longer a visual on the children who were on the deck. Licensee went outside and observed the gate had been unlatched and the children were missing. Licensee placed the infants in their crib and began to search for the missing children, in the front of the house, inside of the house and in the wooded rear yard, which does not have any fencing. The rear yard is open to public wooded forest. When licensee could not find the children, she contacted parents, and began to search for the children again, when parents arrived. When the children were not found, licensee contacted the sheriff's department and they were able to locate the two children safe and unharmed. The two children had walked through the wooded area, down a path which led to the villas at the bottom of the hill.

As a result of the incident that occurred, LPA issued an A citation with a civil penalty. Deficiency will be on an 809D
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HURST-LEWIS, REJANE
FACILITY NUMBER: 313624592
VISIT DATE: 11/08/2024
NARRATIVE
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For a Type A violation, currently enrolled families and all newly enrolled families must review this report from this day forward, for one year (until 11/8/2025) and have the LIC 9224 (acknowledging report) signed and placed in each file for all currently enrolled families and newly enrolled. Failure to do so will result in a subsequent violation.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HURST-LEWIS, REJANE
FACILITY NUMBER: 313624592
VISIT DATE: 11/08/2024
NARRATIVE
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Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/08/2024 12:40 PM - It Cannot Be Edited


Created By: Michelle Perez On 11/08/2024 at 12:02 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: HURST-LEWIS, REJANE
FACILITY NUMBER: 313624592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2024
Section Cited
CCR
102417(a)

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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This was not evidenced by, two children leaving the rear-yard deck, unlatching the lock and wandering away for a period of 40 minutes. Children were found by the Sheriff's department.
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Licensee has decided not to take children outside to the rear-yeard, and has informed parents, children will remain inside, until she replaces the gate with one that has more safety measures. Licensee has also placed a stick on the rear sliding door that perevents children from opening the door.
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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:Amanda Blesi
LICENSING EVALUATOR NAME:Michelle Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2024


LIC809 (FAS) - (06/04)
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