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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623094
Report Date: 02/24/2025
Date Signed: 02/24/2025 11:35:06 AM

Document Has Been Signed on 02/24/2025 11:35 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:FOREST LAKE CHRISTIAN, INC. (PS)FACILITY NUMBER:
293623094
ADMINISTRATOR/
DIRECTOR:		QUADRO, LAURENFACILITY TYPE:
850
ADDRESS:22924 WEST HACIENDA DRTELEPHONE:
(530) 269-1540
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 6DATE:
02/24/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Lauren QuadroTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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At 9:15am on 2/24/2025, Licensing Program Analyst (LPA) Matthew Gallo met with facility representative Julie Hernandez to conduct a plan of correction visit related to citations issued on 2/18/2025. Upon arrival, LPA observed a census of 6 preschool children supervised by one qualified teacher.

Licensee was previously cited a Type A deficiency on 2/18/2025 due to aides providing supervision to children without being under the direct supervision of a teacher themselves. The plan of correction stated that the director will work with facility administrators to ensure that enough qualified teachers are on staff to ensure that children are not left alone with aides when teachers take mandatory or personal breaks. During today's visit, LPA observed two qualified teachers to be on staff and present on the premises and determined that there is a functional schedule in place to ensure that a teacher is always supervising the children. The plan of correction has been fulfilled and is now cleared.

Exit interview conducted and report was reviewed with the facility representative, Julie Hernandez. A notice of site visit was given and must remain posted for 30 days. LPA provided appeal rights.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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