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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093600737
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:37:37 PM


Document Has Been Signed on 05/25/2023 01:37 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:EARLY LEARNING CENTERFACILITY NUMBER:
093600737
ADMINISTRATOR:FIERI, KARRIEFACILITY TYPE:
850
ADDRESS:6767 GREEN VALLEY RDTELEPHONE:
(916) 622-7130
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY:96CENSUS: 0DATE:
05/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jenny PettitTIME COMPLETED:
01:45 PM
NARRATIVE
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On May 25th, 2023 Licensing Program Analysts (LPA) Soleil Marx met with Program Director, Jenny Pettit, to conduct an unannounced case management inspection regarding lead testing. During today's inspection there were no children in care, the school is closed for the summer. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in one of the facility water outlets.

On 05/11/2023, the facility tested water samples for lead. The Lead Testing identified one water outlet that has a Lead Exceedance over the amount of 5.5ppb. The water outlet sampled is marked C, which has an exceedance of 5.8ppb.

This water outlet in exceedance is in classroom M2, which has been vacant and not been utilized by children for the 2022/2023 school year. The facility plans to reopen and use classroom M2 for children during the 2023/2024 school year. The water source sampled C has been shut off and is in inoperable state, making it inaccessible to children.The facility has a Primo filtered water dispenser in classroom M2, to utilize for water for children in care, when the school opens again in the Fall. The facility plans to retest the water outlet in Fall when school resumes and will notify licensing prior to use.



Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected.

An exit interview was conducted with the Program Director. LPA provided Program Director with Appeal Rights, and a Notice of Site Visit was provided that must be posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/25/2023 01:37 PM - 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: EARLY LEARNING CENTER
FACILITY NUMBER: 093600737

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Water outlet was not in use, due to being in a a vacant classroom. Water outlet has been shut off and is in inoperable state. A primo water station will be used as the alternate water source. Facility will retest in the Fall when school resumes and will notify licensing office prior to utilizing.
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Based on record review, one water outlet tested exceeded the allowed 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons 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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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