<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100408954
Report Date: 11/28/2022
Date Signed: 11/28/2022 03:44:04 PM

Document Has Been Signed on 11/28/2022 03:44 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-EWINGFACILITY NUMBER:
100408954
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:4873 E. OLIVETELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 31DATE:
11/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Renee WhiteTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/28/2022 Licensing Program Analysts (LPAs) Ka Vang and Araceli Gibson conducted an unannounced case management inspection. LPA met with Teacher who accompanied LPAs on a tour of the facility. Census was taken and there are 31 children present during today’s inspection. The purpose of today’s inspection is to address 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 that the facility has a high lead exceedance from a recent water lead sampling test collected on 10/26/22. Based on records reviewed from the Environmental Laboratory Accreditation Program (ELAP) report, and self-reported information for FUSD-Ewing (LIC #: 100408954), the water fountain in the classroom 19 Bubbler (outlet A) had a result over the ALE of 5.5 ppb. Based on the incident report submitted and LPA's observation, the facility has made the outlet inoperable, and is in the planning stages of repairing the outlet. The facility is providing alternative potable water via the water fountain in classroom 19 to children, visitors, and staff during hours of operation

Per PIN 21-21 CCP WD 101704 (b)(3), parents/authorized representatives have been notified of the ALE and any corrective action being taken, and results of the lead testing results have been posted on the parent board. Licensee submitted the following documents along with the incident report: Facility Sketch (LIC 999) for both indoor and outdoor areas, Child Care Center Sampling Checklist form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275), Lead testing results for the facility, from LA Testing, Pictures of faucets/fountains being tested. The facility has agreed to continue with the re-sampling process for an action level result of under 5.5 ppb for compliance.

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). Teacher was provided a copy of appeal rights. An exit interview was conducted with the Teacher.

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.

Michael Duarte
Ka Vang
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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 11/28/2022 03:44 PM - It Cannot Be Edited


Created By: Ka Vang On 11/28/2022 at 02:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-EWING
FACILITY NUMBER: 100408954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2022
Section Cited

1
2
3
4
5
6
7
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.
8
9
10
11
12
13
14
 This requirement was not met evidence by based on record review provided by Licensee Classroom 19 bubbler outlet A has a result indicating out of compliance over (ALE) 5.5 ppb, which poses a potential health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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:Michael Duarte
LICENSING EVALUATOR NAME:Ka Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022


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