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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404094
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:32:32 PM


Document Has Been Signed on 11/17/2022 03:32 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:FUSD-WEBSTER CHILD DEVELOPMENT CENTERFACILITY NUMBER:
100404094
ADMINISTRATOR:MADDEN, KATHERINE (KAY)FACILITY TYPE:
850
ADDRESS:930 N. AUGUSTATELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93701
CAPACITY:66CENSUS: 16DATE:
11/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Luis Figueroa PalaciosTIME COMPLETED:
03:45 PM
NARRATIVE
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On 11/17/22 Licensing Program Analysts (LPAs) Priscilla Zamudio and Araceli Gibson conducted an unannounced case management inspection. LPAs met with Luis Figueroa Palacios, Site Supervisor for the purpose of conducting a case management inspection, regarding a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from the Environmental Laboratory Accreditation Program (ELAP) report and self reported information for FUSD Webster CDC License # 100404094 impacted with an(ALE of 18.8 ppb in outlet A Kitchen Faucet Left) and (ALE of 23.1 ppb in outlet B Kitchen Faucet Right). These results indicate out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Outlets have temporarily been made inoperable and are in the planning stages of repair. Site supervisor agrees to continue with the resampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler.

Site supervisor is providing water to the preschool children by means of alternative water fountains that have been tested and are in compliance. Fresh potable water available to preschool children, visitors and staff during hours of operation. Parents have been notified of the (ALE ) Per PIN 20-20 CCP WD 101704 (b)(3). Facility also posted results for parents to review Per PIN 20-20 CCP WD 101703 (b).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809 D). Site Supervisor was provided a copy of appeal rights. An exit interview was conducted. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
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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Document Has Been Signed on 11/17/2022 03:32 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: FUSD-WEBSTER CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 100404094

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited

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California Lead Action Level at Child Care Centers (a) California’s Action Level for lead in water at Child Care Centers is 5 ppb. (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
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This requirement was not met evidence by based on record review provided by Licensee indicating (ALE of 18.8 ppb in outlet A Kitchen Faucet Left) and impacted with an (ALE of 23.1 ppb in outlet B Kitchen Faucet Right). These results indicate out of compliance over (ALE) 5.5 ppb, which is out of compliance. This poses 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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