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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090320884
Report Date: 10/07/2022
Date Signed: 10/12/2022 11:51:58 AM


Document Has Been Signed on 10/12/2022 11:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:EL DORADO COUNTY FEDERATED CHURCH PRESCHOOLFACILITY NUMBER:
090320884
ADMINISTRATOR:REEVES,KELLYFACILITY TYPE:
850
ADDRESS:1031 THOMPSON WYTELEPHONE:
(530) 622-5226
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY:43CENSUS: 13DATE:
10/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Janell PalmerTIME COMPLETED:
03:00 PM
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On October 7th, 2022, Licensing Program Analyst (LPA) Arianna Manabat met with Facility Representative Janell Palmer for an unannounced Case Management Inspection regarding exceedance in lead testing. LPA observed 13 children in care with four staff members. The purpose of today’s inspection was to follow up regarding water sampling that indicated Action Level Exceedance (ALE) for a sink faucet located in the preschool classroom, room 4. This sink faucet tested for lead levels on 08/23/2022. On 09/16/2022, the facility was notified that water levels were in exceedance of 96 parts per billion in the sink faucet that was tested.

LPA Manabat conducted interviews with staff members in the facility and has obtained information indicating that the faucet is not utilized for drinking water. LPA Manabat has observed the kitchen area, jugs, and bottles of water that are utilized for drinking water. Based on this interview and observation, LPA Manabat has found that the faucet in room four is not utilized for drinking purposes. LPA Manabat was informed that if the jug of water is empty, or needs to be refilled, staff will utilize the kitchen sink and ice located in the freezer to refill the jug. LPA Manabat has determined that the faucet is not used for drinking, cooking, or any daily activities involving ingestion.

Through interview, LPA Manabat has obtained information indicating that, although the sink is not utilized for drinking water, the facility has replaced the faucet with a new fixture the week of 9/16/2022.

LPA Manabat has notified facility representative that no deficiencies are cited at this time. LPA reviewed this report with the the Facility Representative and conducted an exit interview. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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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