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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093625277
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:08:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2024 and conducted by Evaluator Soleil Marx
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240823111505
FACILITY NAME:APPLESEEDS ACADEMY INCFACILITY NUMBER:
093625277
ADMINISTRATOR:WALSH, JANIKAFACILITY TYPE:
830
ADDRESS:1735 LAKE TAHOE BLVD RM 3TELEPHONE:
(530) 208-8216
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:15CENSUS: 9DATE:
11/06/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kalei WalshTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not documenting the sleep log accurately
Staff are not documenting the feeding log accurately
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Soleil Marx met with Director, Kalei Walsh, for the purpose of delivering findings to a complaint investigation.It was alleged that staff are not documenting the sleep log accurately and that staff are not documenting the feeding log accurately.Throughout the course of investigation, LPA obtained relevant documentation, reviewed records, made observations, and conducted interviews.

LPA observed meals and bottles being documented on daily activity logs. LPA observed naps being documented and sleep checks being conducted while infants sleep. LPA observed records of activity logs being maintained documenting naps and feedings. Staff interviews revealed activity logs are filled out throughout the day as the activity occurs. Interviews with authorized representatives did not reveal concerns regarding the accuracy of documentation of daily activities regarding sleeping or feeding. LPA did not obtain any conclusive evidence during the investigation that would suggest staff are not documenting the sleep log accurately and that staff are not documenting the feeding log accurately.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 03-CC-20240823111505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/06/2024
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is unsubstantiated. No Title 22 deficiencies were issued as a result of the investigation. Exit interview conducted and report reviewed with Director, Kalei Walsh. A Notice of Site Visit was provided that must be posted for 30 days. Appeal Rights provided.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2