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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 041372369
Report Date: 01/18/2023
Date Signed: 01/18/2023 10:24:03 AM


Document Has Been Signed on 01/18/2023 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:PALERMO STATE PRESCHOOLFACILITY NUMBER:
041372369
ADMINISTRATOR:BUTCHER, KIMBERLYFACILITY TYPE:
850
ADDRESS:7350 BULLDOG WAYTELEPHONE:
(530) 533-4842
CITY:PALERMOSTATE: CAZIP CODE:
95968
CAPACITY:48CENSUS: 35DATE:
01/18/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Kimberly BurcherTIME COMPLETED:
10:25 AM
NARRATIVE
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On 1/18/2023 at 09:05 AM, Licensing Program Analyst (LPAs) J. Helton and L. Chavez made a case management inspection and met with Director of Maintenance Carlos Aguilar. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb or greater) of lead in the water:

North Playground Water Fountain F tested at 13.7

North Playground Bottle Fill F tested at 15.6

Kitchen RH Prep Faucet B tested at 5.51

The kitchen faucet was shut off and bagged/tied closed until it can be replaced. Estimated new faucet arriving by 1/20/23 and will be replaced by maintenance and retested. The water fountain and bottle fill are locked closed and awaiting retesting results.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the Site Supervisor Kimberly Butcher.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie HeltonTELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
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 01/18/2023 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: PALERMO STATE PRESCHOOL
FACILITY NUMBER: 041372369

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/08/2023
Section Cited

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101700.3(b)(1) California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidenced by:
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The licensee has made the faucet and water bottle fill station inaccessible by shutting off the water and locking it closed. The kitchen faucet is bagged and locked until new faucet arrives. All will be retested before continued use.
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Based on record review, the facility had 2 faucet(s) and a prep kitchen sink with lead test results at or exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to children 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: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie HeltonTELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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