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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808012
Report Date: 02/01/2023
Date Signed: 02/01/2023 09:48:56 AM


Document Has Been Signed on 02/01/2023 09:48 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:CHILD DEVELOPMENT-STATE PRESCHOOL-GARFIELDFACILITY NUMBER:
103808012
ADMINISTRATOR:CHARLENE KIYUNAFACILITY TYPE:
850
ADDRESS:1315 N PEACHTELEPHONE:
(559) 327-3402
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:25CENSUS: 19DATE:
02/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kaaren RamseyTIME COMPLETED:
10:00 AM
NARRATIVE
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On 02/01/2023 Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection. LPA met with Teacher, Kaaren Ramsey, who accompanied LPA on a tour of the facility. 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) from water at the facility.

Fresno Regional Office received notification that the facility has a high lead exceedance from a water lead sampling test collected on 12/20/22. Based on records reviewed from the CA Water Board Data Management System, and self-reported information from the facility, Outlet A (PRESCHOOL BUBBLER) shows an ALE of 9.79 ppb. Based on documentation submitted and LPA's observation, the facility has made the outlet inoperable, and has already permanently removed the outlet from the classroom. The facility is providing alternative potable water via Valley Springs Water Service to children, visitors, and staff during hours of operation. 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.


Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee 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.

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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 02/01/2023 09:48 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: CHILD DEVELOPMENT-STATE PRESCHOOL-GARFIELD
FACILITY NUMBER: 103808012

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2023
Section Cited

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(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. Testing results with fractional ppb readings of less than 0.5 ppb shall be rounded down 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. (2) Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. (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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Licensee has ceased operation of the affected outlet and permanently removed the oulet from the facility. Licensee has notified parents/authorized representatives of ALE and corrective action being taken. Licensee has posted results on parent board. Deficiency cleared.
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This requirement was not met as evidenced by: Based on record review, the facility had an ALE of 9/79 ppb in Outlet A, which 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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2