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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293617487
Report Date: 03/05/2020
Date Signed: 03/05/2020 02:46:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WELLS, DARLENEFACILITY NUMBER:
293617487
ADMINISTRATOR:WELLS, DARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 273-2229
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY:14CENSUS: 11DATE:
03/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Whitney WellsTIME COMPLETED:
03:00 PM
NARRATIVE
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Please Note: All times noted in the report are an approximation.
On Thursday, March 5th, 2020, at approximately 1:34pm, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee's adult daughter, Whitney Wells, for the purpose of an unannounced Annual Required inspection. The Licensee's adult son was also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. At 1:37pm, 4 infants and 6 preschool age children were observed. The inspection was conducted with Ms. Wells since the Licensee was not present and unavailable at the time of the visit.

Operating hours are 7:30am to 5:30pm, Monday through Friday, year around.

At 1:37pm, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include the Entire Upstairs and Well House. Ms. Wells acknowledged that children may never enter these off-limit areas.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors. Ms. Wells stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children. There are stairs in the home which are properly barricaded. Safe toys and play equipment are observed.

The outdoor play space is fenced. The Ms. Wells understands that in unfenced outdoor areas, 100% supervision of children is required. There are no bodies of water on the premises.

*Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: WELLS, DARLENE
FACILITY NUMBER: 293617487
VISIT DATE: 03/05/2020
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*Continuation of LIC 809

At 1:51pm, LPA began to review Children’s files and other documentation. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented. Preventative health training, current pediatric CPR and First Aid certification was verified for Ms. Wells (expires 8/2020) and the Licensee. Mandated Reporter Training (AB 1207) for the Licensee and Ms. Wells was also verified.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated 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) (800-514-0383 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

LPA provided and discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370).

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.



In the areas that were evaluated, there were no deficiencies at this time.

At 2:40pm, LPA reviewed and discussed this facility evaluation report with Ms. Wells.



LPA provided a Notice of Site Visit and Ms. Wells acknowledges that this notice shall remain posted for 30 days for parental review.

The Ms. Wells' signature on this form acknowledges receipt of this form.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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