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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406332
Report Date: 11/09/2022
Date Signed: 11/09/2022 09:57:13 AM


Document Has Been Signed on 11/09/2022 09:57 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:FUSD-CALWAFACILITY NUMBER:
100406332
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:4303 E. JENSENTELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY:40CENSUS: 16DATE:
11/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mary XiongTIME COMPLETED:
10:15 AM
NARRATIVE
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On 11/9/22 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with Early Learning Coach, Mary Xiong. The purpose of today's inspection is to discuss the lead exceedance, referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

The Fresno Regional Office, Community Care Licensing, received notification of water lead exceedance at the facility resulting from a recent water lead sampling testing. Records were reviewed from LA Testing, with Mary Xiong , and LPA inspected the drinking fountain outlet in the preschool room 1 ID C (6.49 ppb). LPA observed the drinking fountain to have the water shut off. Mrs. Xiong reported that a maintenance request was made to change out the drinking fountain outlet and replace the fixture. An IGLOO with water from the preschool classroom 2 is available to children, as an alternative water source for drinking. (See Plan of correction for further corrective action 809D). Parents or authorized representatives were notified of the lead testing results and the lead testing results were also posted for parents to view.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). An exit interview was conducted with Mary Xiong and she was provided a copy of this report, along with appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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 11/09/2022 09:57 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: FUSD-CALWA
FACILITY NUMBER: 100406332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2022
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 LA Testing, one of outlets in the facility tested over the allowable ALE 5.5 ppb. This poses a potential health, safety or personal rights risk to persons in care.

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The licensee understands that they will need to resample the fixture by a certified sampler and that they will need to provide evidence of the outlets testing at or below the Action Level.

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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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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