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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623408
Report Date: 10/22/2021
Date Signed: 10/22/2021 12:54:12 PM

Document Has Been Signed on 10/22/2021 12:54 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:SUMMER, DEANNAFACILITY NUMBER:
293623408
ADMINISTRATOR:SUMMER, DEANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 626-1364
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Deanna Summer - LicenseeTIME COMPLETED:
01:05 PM
NARRATIVE
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On Friday, October 22nd, 2021, at 10:57am, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Deanna Summer, for the purpose of an unannounced Annual Required inspection. The Licensee's Husband and two helpers were also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. At 10:57am, 1 infant, 7 preschool, and 2 school age children were observed.

Operating hours are 7:00am to 5:30pm, Monday through Friday, year around.

At 10:59am, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include the Garage, Shed, Upper Deck, Maser Bed/Bathroom, Mud & Laundry Rooms, Daughter's Bedroom. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors.

Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children.

The fireplace in the home is appropriately barricaded to prevent access by children. There are no stairs in the home and the stairs outside of the the home are properly barricaded.

*Continued on LIC 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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: SUMMER, DEANNA
FACILITY NUMBER: 293623408
VISIT DATE: 10/22/2021
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*Continuation of LIC 809

Safe toys and play equipment are observed. The outdoor play space consist of a small lower deck and a large outdoor space that is partially unfenced. The Licensee understands that 100% supervision is required when the children are utilizing the deck as well as the play area. There are no bodies of water on the premises.

At 11:31am, LPA began to review Children’s files and other documentation. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented.

Incidental Medical Services (IMS) policy was discussed. 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

LPA provided and discussed the Safe Sleep in Child Care regulations as well as current Covid-19 guidelines.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.



In the areas that were evaluated, there were no deficiencies at this time.

At 12:45pm, LPA reviewed and discussed this facility evaluation report with the Licensee.



LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice shall remain posted for 30 days for parental review.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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