093625277-11-17-2023-03-CC-AMAT-CXNRAU-20231117115142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093625277
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:52:42 AM

Document Has Been Signed on 11/17/2023 11:52 AM - 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		FACILITY NUMBER:	093625277
ADMINISTRATOR:	FERREIRA, LEIGH ALLEN		FACILITY TYPE:	830
ADDRESS:	1735 LAKE TAHOE BLVD RM 3		TELEPHONE:	(530) 208-8216
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 0	DATE:	11/17/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:			TIME COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and Licensing Program Analyst (LPA) Soleil Marx met with Facility Representative LEIGH ELLEN FERREIRA and Director Janika Walsh for the purpose of an announced pre-licensing inspection. Applicant requests an infant license to serve 15 infant children from birth to two years of age. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. The fire clearance was received and granted on 10/25/2023. The facility will be providing morning snack and afternoon snacks. Parents will provide formula, breast milk, and baby food for their children for their lunch. LPAs reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. INDOOR ACTIVITY SPACE: There is one infant classroom. CAB LPA observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, napping cots, and four cribs. There is a first aid kit in the classrooms. Medications will be stored in the classroom locked storage container atop the cabinet. CAB LPA observed cleaning disinfectants are appropriately stored and inaccessible to children in the cabinet above the microwave. Applicant stated there are no poisons or firearms on the premises. Applicant stated there will be a water pitcher and cups available in the classrooms. LPAs observed a built in functional dual smoke and carbon monoxide detector in all classrooms. LPAs observed a sign-in/sign-out system and binder system. Report continues on LIC809-C.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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	FACILITY NUMBER: 093625277
	VISIT DATE: 11/17/2023

NARRATIVE

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LPAs measured the classroom. The total classroom space contains a total of 809.92 square feet, which will accommodate the Applicant's request for 15 infant children. There are no toilets and 1 sink for the children, and a separate private restroom for the staff located in the next to the kitchen. LPAs observed a changing table within arm's reach of a sink. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the quiet corner, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area on the property. The outdoor play area is fenced with a green chain-linked fence that is at least four feet tall. The Preschool and infant programs will share the space. A waiver request is being submitted as of 11/17/2023. Applicant understands that a Shared Outdoor Space Waiver must be requested and to include outdoor schedules to show no commingling between the age groups. LPAs observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees.

CAB LPA use measurements from the previous pre-licensing for the outdoor space. The outdoor area measured a total of 1667.73 square, which will accommodate Applicant's request for 15 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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, available at: http://www.ada.gov/childqanda.htm

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity, including aide units and qualifications; staff qualifications; and maintaining buildings and grounds. CAB 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.

Report continues on LIC809-C.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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	FACILITY NUMBER: 093625277
	VISIT DATE: 11/17/2023

NARRATIVE

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Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Exit interview conducted and report was reviewed with the applicant.

The following item is required before a license will be issued:
1. New crib dividers that meets regulations.
2. Waiver request for the preschool and infants to utilize the same playground.
3. Licensing Program Manager (LPM) Mai Lor final file review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC809 (FAS) - (06/04)

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