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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622794
Report Date: 05/25/2023
Date Signed: 05/25/2023 12:10:51 PM

Document Has Been Signed on 05/25/2023 12:10 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MUCK AND WONDER FARM SCHOOLFACILITY NUMBER:
343622794
ADMINISTRATOR:MAGGARD, JENNAFACILITY TYPE:
850
ADDRESS:1949 BELL STREETTELEPHONE:
(916) 925-6673
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 39TOTAL ENROLLED CHILDREN: 39CENSUS: 23DATE:
05/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Morgan CottonTIME COMPLETED:
12:20 PM
NARRATIVE
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On May 25, 2023 at approximately 10:20 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Facility Representative Morgan Cotton to follow up on a self-reported incident involving a child injured while in care. During today's investigation, there were 23 children supervised by 4 staff.

The initial report stated that on May 4, 2023 a child was injured falling from a rope swing. According to the report, three staff witnessed the incident and parents were notified immediately. During today's investigation, LPA interviewed staff and made observations. According to staff interview, the child was supervised at the time of the incident, but the injury took place too quickly to be prevented. LPA observed that the ground below the rope swing is padded by loose hay and a foam pad. Staff interview revealed that additional hay and the foam pad were added since the incident.

This report and appeal rights were printed and provided to the Facility Representative. A Notice of Site Visit was printed and must remain posted in the facility for 30 days following today's investigation.

Due to insufficient padding at the time of the incident, a deficiency is cited on the following LIC 809-D page.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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Document Has Been Signed on 05/25/2023 12:10 PM - It Cannot Be Edited


Created By: Josiah Gathing On 05/25/2023 at 11:47 AM
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: MUCK AND WONDER FARM SCHOOL
FACILITY NUMBER: 343622794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
101238.2(e)

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101238.2 Outdoor Activity Space (e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.
This requirement was not met as evidenced by:
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Facility added additional hay and a foam pad under the rope swing for more cushioning.
LPA observed the additional padding during today's investigation and the deficiency was cleared.
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Based on interviews the facility did not comply with the above regulation as the padding under the rope swing was not sufficient to absorb a child's fall which poses Health, Safety, or Personal Rights risk to persons in care.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Josiah Gathing
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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