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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293622609
Report Date: 04/28/2023
Date Signed: 04/28/2023 03:16:16 PM

Document Has Been Signed on 04/28/2023 03:16 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WILD DUCKS & DUCKIES (PS)FACILITY NUMBER:
293622609
ADMINISTRATOR:WRIGHT, AMYFACILITY TYPE:
850
ADDRESS:15725 MT. OLIVE ROADTELEPHONE:
(650) 208-9619
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 16DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Amy WrightTIME COMPLETED:
03:25 PM
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At 12:55pm, Licensing Program Analyst (LPA) Matthew Gallo met with Assistant Director Amanda DePew for the purpose of an unannounced annual random inspection. Director Amy Wright arrived approximately twenty minutes later. Upon arrival, LPA observed 16 preschool children being supervised by 2 staff. Director explained that the presence of the 16th child was only to an emergency situation experienced by the child's family and was meant to only be for a few hours. Facility hours of operation are 8:30am-2pm. Facility does not offer transportation services.

LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. All required postings were observed. Director stated there were no poisons or firearms on the premises, and LPA did not observe any bodies of water. All toxic and hazardous items were inaccessible to children. Functional carbon dioxide detector and smoke detector were present. Furniture and equipment were in good condition and the floors were clean. Playground equipment and surfaces were free of loose or sharp parts, and the areas underneath or around climbing equipment were sufficiently cushioned with wood chips. Program provides morning and afternoon snacks and menus were posted in visible sight. The food preparation space was free of litter and all food was protected against contamination. Storage containers with solid waste had tight-fitting covers. Drinking water was readily available to children both indoors and outdoors. Sufficient napping equipment was available. LPA observed full legal signatures while reviewing the sign in and sign out sheet. Program does not administer medication.

LPA reviewed 6 children's files which were observed to be complete. Review of staff records confirmed at least one staff member present today has current Pediatric CPR and First Aid certification, and that all staff currently employed with the facility have valid AB1207 Manded Reporter Training certificates. Criminal record clearances were also verified, and facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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: WILD DUCKS & DUCKIES (PS)
FACILITY NUMBER: 293622609
VISIT DATE: 04/28/2023
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LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

Director was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining child care centers.

Due to the exceedence of the licensed capacity of 15 children, a Type A Title 22 deficiency is cited on the subsequent 809-D page of this report.



Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

Exit interview conducted and report was reviewed with the facility representative Amanda DePew. Appeal rights and a Notice of Site Visit were provided, the latter of which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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Document Has Been Signed on 04/28/2023 03:16 PM - It Cannot Be Edited


Created By: Matthew Gallo On 04/28/2023 at 02:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: WILD DUCKS & DUCKIES (PS)

FACILITY NUMBER: 293622609

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.3(a)(1)
Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. (1) The number of children in attendance shall not exceed licensed capacity.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by providing care for 16 children due to an emergency situation of the 16th child's family. This excedes the licensed capacity of 15 preschool children and poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2023
Plan of Correction
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Licensee acknowledges that they can never excede their licensed capacity of 15 and will submit a written plan to LPA detailing how they will handle emergency situations in the future.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
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