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Department of
SOCIAL SERVICES

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293606323
Report Date: 10/25/2016
Date Signed 10/25/2016 01:30:28 PM

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:	OUR KIDS' PLACE		FACILITY NUMBER:	293606323
ADMINISTRATOR:	CAROL VIOLA		FACILITY TYPE:	850
ADDRESS:	10846 GILMORE WAY		TELEPHONE:	(530) 274-9106
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	45	CENSUS: 17	DATE:	10/25/2016
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Carol Viola		TIME COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Amie Randa met with Director Carol Viola and Site Supervisor Rachael Pool for an unannounced annual inspection. Today’s census was 17 preschool aged children and three staff members, who have all been finger-print cleared through Community Care Licensing. LPA toured the facility including all activity/classroom areas, food service area and restrooms. LPA observed that furniture and equipment are in good condition, the food preparation area is kept clean and sanitized and the restrooms are safe and sanitary. Director stated that the facility provided morning/afternoon snack and lunch is provided through the Grass Valley School District and LPA observed a current snack menu posted. LPA observed that at least one staff member present during today’s inspection has a current Pediatric CPR/First Aid that expires on 01/2017. LPA observed that poisons are locked, cleaning compounds are inaccessible to children and Director stated there are no firearms or bodies of water on the property. LPA reviewed care and supervision of children and staffing ratios, there is at least one teacher for every 12 children in care. Director stated the facility does not administer medications to children. LPA reviewed children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative. LPA reviewed staff's educational background /transcripts. LPA observed that outdoor activity space surfaces are free of hazards, playground equipment is in safe condition and drinking water is made readily available to children both indoors and outdoors. Report continued on 809 C

SUPERVISOR'S NAME: Jennifer Brekke	TELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Amie Randa	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2016

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2016

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: OUR KIDS' PLACE	FACILITY NUMBER: 293606323
	VISIT DATE: 10/25/2016

NARRATIVE

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LPA discussed Departments inspection authority regulations with the Director and informed her that if any changes occur regarding the Designee/Site Supervisor or an employee acting in their absence must be reported to Department within 10 working days. LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.

LPA provided the Community Care Licensing’s website (www.ccld.ca.gov), so the licensee can obtain updated licensing information, new regulations and access forms.

LPA discussed the Immunization laws and Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA read the report to the Director and she stated that she acknowledges/understands today's inspection. No Title 22 deficiencies were observed in the areas that were evaluated. LPA provided Appeal Rights and Notice of Site Visit was posted.

SUPERVISOR'S NAME: Jennifer Brekke	TELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Amie Randa	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2016

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2016

LIC809 (FAS) - (06/04)

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