293622610-7-18-2019-03-CC-BMOS-BE7RSY-20190718131732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293622610
Report Date: 07/18/2019
Date Signed: 07/18/2019 01:17:37 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:	WILD DUCKS & DUCKIES (SA)		FACILITY NUMBER:	293622610
ADMINISTRATOR:	WRIGHT, AMY		FACILITY TYPE:	840
ADDRESS:	15725 MT. OLIVE ROAD		TELEPHONE:	(650) 208-9619
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	24	CENSUS: 2	DATE:	07/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Amy Wright		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Blake Morillas met with the Director, Amy Wright, for the purpose of an unannounced Annual/Random inspection. Today’s census was 2 School age children and 8 Preschool age children (Commingling Waver on file). The facility operates year around, but is currently operating its Summer Program with the schedule of Monday through Friday from 7:30am to 5:30pm. LPA observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPA inspected the food service area and observed that the food products appeared to be protected against contamination. Menus were posted. LPA reviewed care and supervision of children, staffing ratios, health related services (including medications and first aid supplies), furniture, and equipment. Drinking water is readily accessible to children in care. LPA observed sinks, and toilets to be operable. There are adequate toys, equipment, and supplies available for the children. LPA inspected the outdoor play area and observed equipment to be in safe condition, with adequate cushioning material. Shaded areas are also available. LPA observed all required forms to be posted. First aid supplies were also available. LPA reviewed the sign/in-sign/out sheet and reviewed children’s and staff's files. *Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: WILD DUCKS & DUCKIES (SA)	FACILITY NUMBER: 293622610
	VISIT DATE: 07/18/2019

NARRATIVE

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*Continuation of LIC 809

All staff currently employed with the facility have criminal record clearances, health screening reports with TB test, and Mandated Reporter training. At least one staff member present today has current Pediatric CPR and First Aid.

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

LPA provided the Licensing Agency website (www.ccld.ca.gov), so the Director may obtain updated licensing information, regulations, and forms.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

In the areas that were evaluated, no deficiencies were cited during the visit.

Report was reviewed with the Director and an exit interview was conducted.

Notice of Site Visit posted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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