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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093628065
Report Date: 09/24/2026
Date Signed: 09/24/2026 01:24:22 PM

Document Has Been Signed on 09/24/2026 01:24 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:
093628065
ADMINISTRATOR/
DIRECTOR:		LEIGH-ALLEN, FERREIRAFACILITY TYPE:
860
ADDRESS:1100 LYONS AVENUETELEPHONE:
(530) 208-8216
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 32TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/24/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Leigh-Ellen FerreiraTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On September 24, 2026 at approximately 11:00 AM, Licensing Program Analyst (LPA), Josiah Gathing met with Licensee Representative (LR) Leigh-Ellen Ferreira for an announced Pre-licensing inspection. Applicant is requesting a license for 12 Infants (ages 6 weeks to 2 years) in the Infant Room; 20 Preschool children (ages 2 to 5 years) in Preschool Room. The total requested capacity will be 32. Areas of the facility not included in indoor activity space include the Staff Restrooms, Children's Restrooms, and Infant Napping Area. Hours of operation will be Monday through Friday, 7:30 AM to 4:30 PM.

All indoor and outdoor activity space for the children was inspected today. LPA informed LR that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, LR stated that they will be stored in a locked file cabinet in the Preschool Classroom, inaccessible to children. LPA observed a first aid kit in each classroom. There is an operational carbon monoxide detector on site located in the preschool classroom. All required licensing documents were observed posted in the preschool classroom. Children will be signed in and out on paper sign in sheets in each classroom.

LPA measured total indoor infant activity space of 499.76 square feet, which is sufficient to accommodate the requested capacity of 12 Infants. LPA measured total indoor Preschool activity space of 706.75 square feet, which is sufficient to accommodate the requested capacity of 20 Preschool Children. LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, cots, mats, bookshelves, and other activity supplies for the children.


Cont. on LIC809-C...

Belinda Devall
Josiah Gathing
DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 093628065
VISIT DATE: 09/24/2026
NARRATIVE
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Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via individual bottles provided by families. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire safety clearance was granted by the fire department on 7/29/2026.

LPA observed changing tables in each restroom. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing tables are at least 3” high and the changing tables are within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing. The infant napping room is physically separated from the indoor activity space according to regulation. There are 6 cribs meeting regulatory requirements in the infant napping area. LPA advised LR that no more than 6 infants requiring a crib for sleep are to be enrolled unless additional cribs are added. Sleep logs and Needs and Services Plans will be kept in a binder in the infant nap area.

The facility is equipped with 4 sinks and 4 toilets available to children. These are sufficient to accommodate the requested capacity of 32 children. Each classroom has an attached restroom equipped with two toilets and one sink. There are separate staff restrooms equipped with a toilet and sink located in each classroom. There is an additional potty chair in the infant restroom for potty training children. The isolation area for children who are ill will be the staff desk area at the front of the Preschool Room. The isolation restroom for children who are ill will be the staff restroom in the Preschool Room.

The facility will provide snacks each day. Meals will be provided by families. Hazardous solutions and cleaning supplies are stored in an upper cabinet above the sink in preschool room as well as the upper cabinet in the infant restroom, inaccessible to children.

The facility playground is fenced to prevent children from accessing outside areas. Fencing was at least four feet high in all areas. LPA measured Preschool/Infant outdoor activity space of 2,268.2 square feet, which is sufficient to accommodate the requested capacity of 12 infants and 20 preschool children on alternating schedules. There is only one playground available. LR submitted a request for a waiver allowing infants and preschool children to share the outdoor activity space on alternating schedules. Shade is provided by nearby trees. There are sufficient wood chips beneath the play structures to provide cushioning. There are sufficient outdoor toys and play equipment available on the playground. Drinking water is available outdoors via children's individual bottles provided by families.

LR was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.
Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 093628065
VISIT DATE: 09/24/2026
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For child care 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).

LR 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.

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.

LR 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 platforms. 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 and printed for LR, Leigh-Ellen Ferreira.

The following corrections are needed prior to the issuance of the license:

-Waiver approval for shared outdoor activity space.

LR understands that all proof of corrections must be provided to the department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4