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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293617487
Report Date: 11/18/2022
Date Signed: 11/29/2022 09:26:05 AM


Document Has Been Signed on 11/29/2022 09:26 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
RIVER CITY (SACTO)CC, 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: 4DATE:
11/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Darlene WellsTIME COMPLETED:
12:30 PM
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On Friday, November 18th, 2022, at approximately 11:10am, Licensing Program Analyst (LPA) Matthew Gallo and Licensing Program Manager (LPM) Keven Peters met with the Licensee Darlene Wells for the purpose of an unannounced Annual Required inspection. The Licensee's adult daughter was also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. At 11:20am, 1 infants, 1 school-aged, and 2 preschool age children were observed. Operating hours are 3:00pm to 1:00am on Mondays and 8:00am to 1:00am, Tuesday-Friday, year around.

At 11:25am, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include upstairs loft, upstairs bedroom, and master bedroom and bathroom. Ms. Wells acknowledged that children may never enter these off-limit areas. Licensee is making a new upstairs room on-limits. LPA inspected room and ensured that it met all regulations.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee 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. Currently licensee is installing a pellet stove heater and showed LPA the barricade she will use to prevent access to children once complete. 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.

At 11:50am, 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 Licensee (exp 6/2023) and daughter Whitney (exp 6/2023) and Mandated Reporter Training (AB 1207) for the Licensee and daughter Whitney was also verified.
Continued on 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: WELLS, DARLENE
FACILITY NUMBER: 293617487
VISIT DATE: 11/18/2022
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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 12:25pm, LPA reviewed and discussed this facility evaluation report with licensee.



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

Licensee's signature on this form acknowledges receipt of this form.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
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