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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093625166
Report Date: 08/10/2023
Date Signed: 08/10/2023 03:13:38 PM

Document Has Been Signed on 08/10/2023 03:13 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:APPLESEEDS ACADEMY INC SCHOOL AGEFACILITY NUMBER:
093625166
ADMINISTRATOR:FERREIRA, LEIGH ALLENFACILITY TYPE:
840
ADDRESS:1735 LAKE TAHOE BLVDTELEPHONE:
(530) 208-8216
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
08/10/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Leigh Ellen FerreiraTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Soleil Marx and Amanda Sutter met with Applicant, Leigh Ellen Ferreira, for the purpose of an announced pre-licensing inspection. Applicant is requesting a school-age license to serve 22 school-age children enrolled and attending kindergarten and above. The facility is located on the South Tahoe High School campus. The facility will be utilizing “Mt Tallac #1.” The fire clearance was granted on 07/31/2023 by South Lake Tahoe Fire Prevention. Per fire clearance, “classroom #1” is approved for a maximum capacity of 22 school-age children.

The facility hour of operation will be Monday through Saturday from 7:30am to 5:30pm. The program will offer after school care from 12:00pm to 5:30pm Monday through Friday. The facility will operate full day on Saturday's, during school breaks, and Summer program.

LPAs reviewed with applicant the LIC 311A; records to be maintained at the facility to include child’s records, personnel records, and administrative records; and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. The facility will provide morning and afternoon snacks, and children will bring their own lunch.

LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Per Health and Safety Code 1596.806, the facility is exemption from square footage, toilet, isolation space, outdoor activity space, and fencing requirements. LPAs did not measure the indoor or outdoor activity space.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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: APPLESEEDS ACADEMY INC SCHOOL AGE
FACILITY NUMBER: 093625166
VISIT DATE: 08/10/2023
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INDOOR ACTIVITY SPACE:

LPAs inspected Classroom #1. LPAs observed a sufficient number of child size tables, chairs, age-appropriate toys and equipment. There is a first aid kit the classroom. Applicant stated medications and cleaning disinfectants will be stored in the classroom in an out of reach cabinet, inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPAs observed a functional carbon monoxide detector in the classroom. Applicant stated they will be utilizing a paper sign in/out system, in addition to an electronic sign in/out system. Applicant stated water will be provide via water bottle and the facility has water fountains located throughout the school campus, which will be accessible to children in care. Facility will be utilizing the school's admin office for isolation and use the staff restroom if necessary.

Per the Applicant, the facility will have exclusive use of the restrooms near “Mt Tallac classroom #2” on South Tahoe High School campus. The applicant understands she must submit a waiver for the school-age license to share the restrooms with the preschool license.

OUTDOOR ACTIVITY SPACE:

LPAs observed a black top outdoor activity space with basket ball hoops that is exclusive for school-age use. LPAs observed the outdoor activity space to be safe and free of hazards. Applicant stated outdoor activities and age-appropriate outdoor toys and equipment will be offered during outdoor activity time. Shade is provided via awnings and trees.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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: APPLESEEDS ACADEMY INC SCHOOL AGE
FACILITY NUMBER: 093625166
VISIT DATE: 08/10/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Applicant was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Director was informed of the https://mychildcareplan.org/; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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: APPLESEEDS ACADEMY INC SCHOOL AGE
FACILITY NUMBER: 093625166
VISIT DATE: 08/10/2023
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Applicant was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation, and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


A provisional license is granted today, 08/10/23 pending: Licensing Program Manager (LPM) Natalie Dunaway’s final review.

Documents still needed include:

1) Job descriptions for school age staff

2) Updated facility sketches

3) Request for shared space waiver for restroom

Until all documents listed above are received, the license will be in provisional status which will expire November 10th, 2023 and cannot be renewed.

Exit interview conducted and report was reviewed with Applicant, Leigh Ellen Ferreira.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC809 (FAS) - (06/04)
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