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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293622609
Report Date: 05/04/2023
Date Signed: 05/04/2023 12:50:52 PM

Document Has Been Signed on 05/04/2023 12:50 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: 12DATE:
05/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amanda DePewTIME COMPLETED:
01:00 PM
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At 12:00pm on 5/4/2023, Licensing Program Analyst (LPA) Matthew Gallo met with acting director Amanda DePew for the purpose of plan of correction visit. Upon arrival, LPA observed 13 children supervised by 2 staff.

Licensee was previously cited a Type A deficiency on 4/28/2023 for operating beyond the limits of their capacity by providing care for 16 preschool children while they are only licensed to provide care for 15 preschool children. The plan of correction dictated that the Licensee would abide by their licensed capacity of 15 and submit a written plan to LPA detailing how they will handle emergency capacity situations in the future.

Based on today's census, LPA confirmed that the facility is in capacity with fully qualified staff. During today's inspection LPA was able to clear the deficiency cited on April 28, 2023.

In the areas that were evaluated, there were no Title 22 deficiencies cited during today's inspection. Exit interview conducted and report was reviewed with acting director Amanda DePew. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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