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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808458
Report Date: 02/07/2023
Date Signed: 02/07/2023 12:33:08 PM


Document Has Been Signed on 02/07/2023 12:33 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:PANAMA-BUENA VISTA USD-SEIBERT PRE-KGFACILITY NUMBER:
153808458
ADMINISTRATOR:CALDERA, ANAMARIKSAFACILITY TYPE:
850
ADDRESS:2800 AGATE STREETTELEPHONE:
(661) 431-7536
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:48CENSUS: 27DATE:
02/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:K. Dionne WoodTIME COMPLETED:
01:00 PM
NARRATIVE
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On 02/07/2023 Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Case Management inspection and met with K. Dionne Wood, Instructional Services Coordinator. The purpose of today's inspection is to address the lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (PPB) in the water at the facility.

The Fresno South Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test conducted on 12/17/2022. Based on records reviewed from Child Care Center Lead Sampling and Reporting Tool, outlet named M was impacted with an (ALE) of 6.4 PPB and outlet named P was impacted with an (ALE) of 99 PPB. Outlet M, a dishwashing station and outlet P, a 'pot filler' spray hose are both located in the elementary school kitchen. These results indicates out of compliance of over (ALE) 5.5 PPB. (See Plan of correction for further corrective action see page LIC 809-D). Outlets M and P have been temporarily made inoperable. Wood agrees to continue with the re-sampling process for an action level result of under 5.5 PPB for compliance with a Certified Sampler.
Wood stated this site has 2 classrooms (PK1 and PK2) each with 2 sinks containing a bubbler (water fountain) and a spigot. Classroom PK2 also has an additional sink with a spigot. Drinking water is being obtained from the 2 sinks in each classroom which have a "none detected" lead level. The outside play yard has 2 bubblers which also had a "none detected" lead level and is used for drinking water.
Written notices in English and Spanish of ALE are posted on the parent boards in both classrooms PK1 and PK2, per PIN 21-21.1 CCP, WD 101704 (b)(3).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, a type B deficiency is being cited: (see next page, LIC 809-D). An exit interview was conducted with K. Dionne Wood and this report was reviewed and provided. A Notice of Site Visit (LIC 9213) and copy of Appeal Rights was also provided. 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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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 02/07/2023 12:33 PM - 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: PANAMA-BUENA VISTA USD-SEIBERT PRE-KG
FACILITY NUMBER: 153808458

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2023
Section Cited

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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...(1) A result with values of 5.5 PPB or greater shall be deemed an Action Level Exceedance (ALE)...(c) If testing indicates an (ALE) 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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Per Instructional Service Coordinator, K. Dionne Wood, written notices of ALE is posted on both classroom parent boards in English and Spanish. Outlets M and P have been made temporarily inoperable. Wood provided to LPA a written Plan of Action during today's inspection.
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This requirement was not met as evidenced by: Based on record review provided by licensee indicating ALE of 6.4 PPB in outlet M and ALE of 99 PPB in outlet P. 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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Wood agrees to submit evidence of replacement and remediation of outlets M and P located in the school kitchen by testing at or below Action Level by POC due date of 3/7/2023.

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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: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2