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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801741
Report Date: 01/17/2023
Date Signed: 01/18/2023 08:28:48 AM


Document Has Been Signed on 01/18/2023 08:28 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:GREENFIELD STATE PRESCHOOLFACILITY NUMBER:
153801741
ADMINISTRATOR:HERNANDEZ, ROSITAFACILITY TYPE:
850
ADDRESS:5400 MONITOR STREET BLDG. BTELEPHONE:
(661) 398-0426
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:48CENSUS: 14DATE:
01/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Rebecca QuintanillaTIME COMPLETED:
10:25 AM
NARRATIVE
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On 1/17/23, Licensing Program Analyst (LPA) Kathy Pacheco and LPA Denisia Jimenez conducted an unannounced case management inspection at the facility. LPAs met with Site Supervisor Rebecca Quintanilla to discuss the results of the lead testing of the water at the facility.

Based on information obtained from the water lead sampling test conducted by Terraphase Engineering, it was determined there was an Action Level Exceedance (ALE), meaning there was a result with values of 5.5 ppb or greater. The ALE of 6.6 ppb was discovered in water source (G) located in classroom B. Site Supervisor stated as soon as they were informed of the exceedance, the water was immediately shut off to the faucet and plastic was placed over the faucet location with a sign reading "Do not use!". Site Supervisor stated they are in the process of obtaining a new water fountain that allows for water bottles to also be refilled in place of water source (G). Site Supervisor further stated once the new water system is in place, they will have it tested for lead. Site Supervisor also stated a letter was provided to parents and caregivers on 12/15/22 indicating the lead exceedance.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, 101700.3 (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 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:
The following deficiency was cited: (see next page titled 809-D)

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Rebecca Quintanilla.

SUPERVISOR'S NAME: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
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 01/18/2023 08:28 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: GREENFIELD STATE PRESCHOOL
FACILITY NUMBER: 153801741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2023
Section Cited

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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. This requirement was not met as evidenced by results from the water lead sampling test showing an ALE of 6.6 ppb in
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Site Supervisor said water source (G) will be capped immediately and all water source to the fountain was already shut off. We provided a do not use sign and covered the fountain and it will be replaced with a newer water fountain that allows for bottle refills. Site Supervisor also stated a lead test will be conducted on the new
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water source (G). This poses a potential risk to the health, safey, and/or personal rights of children in care.
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water source once it is intalled and the results will be submitted to Licensing. Parents were previously informed of the water lead test results.

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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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
LIC809 (FAS) - (06/04)
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