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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093620107
Report Date: 01/17/2025
Date Signed: 01/17/2025 12:58:59 PM

Document Has Been Signed on 01/17/2025 12:58 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:LTUSD PRESCHOOL PROGRAMFACILITY NUMBER:
093620107
ADMINISTRATOR/
DIRECTOR:		LINDSTROM, AMYFACILITY TYPE:
850
ADDRESS:1100 LYONS AVENUETELEPHONE:
(530) 541-2850
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
01/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Amy LindstromTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On January 17, 2025, Licensing Program Analyst (LPA) Soleil Marx, met with Facility Representative, Amy Lindstrom, for the purpose of conducting an unannounced case management inspection. The purpose of today's inspection was explained. Upon arrival, LPA observed a census of 14 preschool age children being supervised by two staff.

The facility self reported an incident via phone call to LPA Marx and by written Unusual Incident Report LIC624, that on January 10, 2025, a staff member was put on administrative leave by the Lake Tahoe Unified School District Director of Human Resources, pending an internal district investigation regarding alleged personal rights violations.

During today's inspection LPA Marx made observations, obtained relevant documentation, interviewed staff, and interviewed children.



LPA determined the facility to be in compliance with reporting requirements. LPA verified the staff member in question is not currently present at the facility. LPA Marx will conduct further investigation regarding the incident.

No deficiencies are being cited at this time.

Exit interview conducted and report reviewed with Facility Representative, Amy Lindstrom. A notice of site visit was given and must remain posted for 30 days.


SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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