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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093624376
Report Date: 10/17/2024
Date Signed: 10/17/2024 12:38:48 PM

Document Has Been Signed on 10/17/2024 12:38 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 INFANT PROGRAMFACILITY NUMBER:
093624376
ADMINISTRATOR/
DIRECTOR:		SALAZAR, ANDREAFACILITY TYPE:
830
ADDRESS:1100 LYONS AVENUETELEPHONE:
(530) 541-2850
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
10/17/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Amy LindstromTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Soleil Marx met with Facility Representative, Amy Lindstom, for the purpose of conducting an unannounced plan of correction inspection. The purpose of today's inspection was explained. LPA observed a census of seven infants being supervised by two staff.

This facility was cited on 10/02/2024 for being out of compliance with CCR 101439.1(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

During today's inspection, LPA observed all cribs were free of loose articles and objects including blankets. LPA received and reviewed training material for staff to maintain compliance. LPA reviewed a sample of children's files and observed acknowledgement of receipt of licensing reports (LIC9224) were signed by authorized representatives.

Based on today's inspection, LPA determined that the facility implemented and met their plan of correction and are in compliance with CCR 101439.1(f) . LPA will clear the previously cited deficiency.

Exit interview conducted and report was reviewed with Facility Representative. 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: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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