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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 12:53:16 PM

Document Has Been Signed on 10/22/2021 12:53 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:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Deanna Summer - LicenseeTIME COMPLETED:
01:05 PM
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On Friday, October 22nd, 2021, at 10:57am, Licensing Program Analyst (LPA) Blake Morillas conducted a unannounced Case Management visit in regards to a received self reported Unusual Incident Report (UIR). LPA informed the Licensee, Deanna Summer, of the reason for the inspection. At 10:57am, 1 infant, 7 preschool, and 2 school age were observed along with the Licensee's husband and helpers.

On October 19th, the Licensee self reported an incident that took place previous day (10-18-2021), where a child inappropriately touched by another child in care.

At 10:59am, the LPA observed where the incident occurred and conducted interviews of the helper that was present at the time the incident occurred. After conducting interviews and making observations, it was determined that no Title 22 violations took place.

At 12:45pm, the report was reviewed with the Director and an exit interview was conducted.

Notice of site visit posted to be posted for the next 30 days.


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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