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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103808860
Report Date: 01/03/2023
Date Signed: 01/03/2023 10:47:46 AM

Document Has Been Signed on 01/03/2023 10:47 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:CSN EARLY EDUCATION CENTERFACILITY NUMBER:
103808860
ADMINISTRATOR:AVILA, CHRISTINAFACILITY TYPE:
850
ADDRESS:1318 K STTELEPHONE:
(559) 399-3061
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
01/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sally GomezTIME COMPLETED:
11:30 AM
NARRATIVE
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On 1/3/23 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with Site Supervisor, Sally Gomez. 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 11/23/22. Based on records reviewed from the LA Testing, and self-reported information from the facility, the kitchen sink (outlet D) had a result of 9.95 ppb. Based the LPA's observation, the facility has made the outlet inoperable by turning the water off to that outlet, and is planning to replace the outlet. The outlet is used to rinse off dishes before putting them into the dish washer. The facility is providing alternative potable water via purified water jugs 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. 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, 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 Sally Gomez.

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.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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 01/03/2023 10:47 AM - It Cannot Be Edited


Created By: Caroline Harris On 01/03/2023 at 10:25 AM
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: CSN EARLY EDUCATION CENTER
FACILITY NUMBER: 103808860

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2023
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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The licensee agrees to sumbit evidence of remediation on (ALE) of 9.95 ppb in outlet D testing at or below Action Level by 30 days POC due date 01/31/23.
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This requirement was not met evidence by: Based on record review provided by LA Testing indicating (ALE) of 9.95 ppb in outlet D. These results indicate out of compliance over (ALE) 5.5 ppb, 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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023


LIC809 (FAS) - (06/04)
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