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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801139
Report Date: 05/15/2024
Date Signed: 05/15/2024 02:50:32 PM

Document Has Been Signed on 05/15/2024 02:50 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CROSSCITY CHRISTIAN EECFACILITY NUMBER:
103801139
ADMINISTRATOR/
DIRECTOR:		CHAPMAN, TAMMIFACILITY TYPE:
850
ADDRESS:2777 E NEES AVETELEPHONE:
(559) 299-8484
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 96DATE:
05/15/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Tammi ChapmanTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 5/15/24, Licensing Program Analysts (LPAs) Priscilla Zamudio and Aurelio Mendoza conducted an unannounced case management inspection. LPAs met with Director Tammi Chapman, 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 for Crosscity Christian EEC, License # 103801139, impacted with an (ALE of 9.4 ppb in outlet 11A-Playground water fountain). These results indicate out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Outlet has temporarily been made inoperable and is in the planning stages of removal.

Director is providing water to the preschool children by means of personal water bottles which are refilled with outlets that have been tested and are in compliance. Fresh potable water is available to preschool children, visitors and staff during hours of operation. Parents will be notified of the (ALE ) Per PIN 20-20 CCP WD 101704 (b)(3). Facility will also post 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). Director 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.

(Continued LIC 809-D)

SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 05/15/2024 02:50 PM - It Cannot Be Edited


Created By: Priscilla Zamudio On 05/15/2024 at 01:56 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: CROSSCITY CHRISTIAN EEC
FACILITY NUMBER: 103801139

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2024
Section Cited

101700.3

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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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Director will notify and post ALE results at a reasonable location for Authorized representatives to review. Director agrees to provide evidence of the removal of fixture (outlet 11A-Playground water fountain) to community care licensing by POC due date of 6/15/24.
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This requirement was not met as evidence by record review provided by Licensee indicating (ALE of 9.4 ppb in outlet 11A-Playground water fountain). These results indicate 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:Cynthia Brannon
LICENSING EVALUATOR NAME:Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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