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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808574
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:00:55 AM


Document Has Been Signed on 01/13/2023 11:00 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:WILLOW CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808574
ADMINISTRATOR:JONES, NIKOLAFACILITY TYPE:
850
ADDRESS:401 WILLOW DRIVETELEPHONE:
(661) 336-5236
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:56CENSUS: 28DATE:
01/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Shawna MarksTIME COMPLETED:
11:15 AM
NARRATIVE
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On January 13, 2023 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management inspection. LPA McWilliams met with Site Supervisor Shawna Marks. The purpose of today’s inspection was to conduct a case management inspection and to notify the facility that there has been 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. LPA conducted a tour of the facility inside and out and a census was taken.

Fresno South Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from CRWA and discussions with Site Supervisor Marks it has been determined that there is an exceedance to outlet C in the facility. LPA McWilliams inspected outlet C it was observed to be an hand washing sink that was impacted with 17ppb(ALE) of lead. Director Marks, has discontinued the use of the hand washing sink by making the outlet inaccessible; Director Marks also states that it is in the atrium and the children are not in the area and do not use the sink at all. The outlet is in the process of being replaced.

(See plan of correction for further corrective action 809D). Site Supervisor Marks has notified authorized representatives of this corrective action in both languages; English and Spanish.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809D). Site Supervisor were provided a copy of the appeal rights. An exit interview was conducted with Site Supervisor.

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: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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 01/13/2023 11:00 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: WILLOW CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153808574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited

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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 5ppb.(b) Testing results with fractional ppb readings of 0.5ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.
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Director confirmed that the parents/guardians have been notified; LPA observed report posted and letter. Outlet C is in an inaccessible area has been made inaccessible; Director confirmed that outlet C is in the process of being replaced and will be retested.
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(1) A result with values of 5.5ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met by evidence by: Based on record review provided by CRWA a result of (ALE) of 17ppb for outlet C which is out of compliance over the allowable ALE 5.5ppb. 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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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