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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093625166
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:29:56 PM

Document Has Been Signed on 04/09/2024 01:29 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 INCFACILITY NUMBER:
093625166
ADMINISTRATOR/
DIRECTOR:		FERREIRA, LEIGH ELLENFACILITY TYPE:
840
ADDRESS:1735 LAKE TAHOE BLVDTELEPHONE:
(530) 208-8216
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 10DATE:
04/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Kalei WalshTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On April 9th, 2024, Licensing Program Analyst (LPA), Soleil Marx, met with Facility Representative, Kalei Walsh, for the purpose of conducting a case management inspection. LPA observed a census of ten school-age children in care being supervised by an uncleared adult.

During today's visit, LPA observed that one staff member present in the facility had an "In Process" criminal background clearance. Based on record review, LPA found that the staff member is associated to the facility but has not been cleared through the Guardian system. Based on record review and interviews it was determined that the staff member has worked at the facility for more than five days.

Facility Representative 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.

Based on today's inspection, one type A deficiency is being cited on 809-D and a civil penalty is being assessed in the amount of $500 for Caregiver Background Check.


Licensee was informed that this report dated 04/09/2024 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report reviewed with Facility Representative, Kalei Walsh. Notice of site was provided and must remain posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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 04/30/2024 12:04 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/19/2024 10:57 AM


Created By: Soleil Marx On 04/09/2024 at 01:09 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: APPLESEEDS ACADEMY INC
FACILITY NUMBER: 093625166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2024
Section Cited
CCR
101216(i)(1)

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(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(1)Obtain a California clearance or a criminal record exemption as required by law...
This requirement is not met as evidenced by:
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Facility Representatuve stated that the uncleared adult will not return to facility until they have been cleared through the guardian background system and have an eligible clearance or exemption. LPA will do return visit.
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Based on observation, interview, and record review, the facility did not ensure compliance with the section cited above by having an uncleared adult working at the facility, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024


LIC809 (FAS) - (06/04)
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