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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293617487
Report Date: 05/13/2024
Date Signed: 05/13/2024 09:39:55 AM

Document Has Been Signed on 05/13/2024 09:39 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:WELLS, DARLENE & WELLS, WHITNEYFACILITY NUMBER:
293617487
ADMINISTRATOR/
DIRECTOR:		WELLS, DARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 460-9510
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 14; 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Whitney WellsTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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On 5/13/2024, Licensing Program Analyst (LPA) Matthew Gallo met with Co-Licensee Whitney Wells for the purpose of a case management visit. Today's census included 4 children consisting of 2 preschool children and 2 infants.

The purpose of today’s visit is to provide the facility with an amended report for the annual inspection conducted on 5/9/2024. LPA mistakenly referenced a change of capacity from a Large to Small license. LPA provided Co-Licensee Whitney Wells with the amended report.

No Title 22 deficiencies were observed during today's visit.

Exit interview conducted and report was reviewed with Co-Licensee Whitney Wells. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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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