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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808144
Report Date: 04/04/2023
Date Signed: 04/04/2023 12:01:58 PM


Document Has Been Signed on 04/04/2023 12:01 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:YOSEMITE LAKES CHRISTIAN PRESCHOOLFACILITY NUMBER:
203808144
ADMINISTRATOR:PETERSON, ANITRAFACILITY TYPE:
850
ADDRESS:43840 PATRICK AVENUETELEPHONE:
(559) 474-8796
CITY:COARSEGOLDSTATE: CAZIP CODE:
93614
CAPACITY:45CENSUS: 15DATE:
04/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anitra PetersonTIME COMPLETED:
12:15 PM
NARRATIVE
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On 04/04/23 Licensing Program Analysts (LPAs) Denisia Jimenez and Araceli Gibson conducted an unannounced case management inspection. LPAs met with Anitra Peterson Director for the purpose of conducting a case management inspection, regarding 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.

Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from Child Care Center Lead Sampling, Reporting Tool, and self-reported information to licensee # 203808144 two outlets were affected: Outlet A kitchen sink shows an ALE of 13.000 ppb, Outlet B water fountain in the play area shows an ALE of 6.500 ppb. This result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Director agrees to continue with the re-sampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler.


Director stated facility is providing water for the children. Children are bringing in their water bottles and refilled at the facility from bottled water service Sparkletts. Facility will post results for parents to review Per PIN 21-21-1 CCP WD 101703 (b). In addition, parents and guardians will be informed by letter and verbally of the (ALE) 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, 809 D). Director was provided a copy of appeal rights. An exit interview was conducted. 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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Denisia JimenezTELEPHONE: (559) 767-0718
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
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 04/04/2023 12:01 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-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: YOSEMITE LAKES CHRISTIAN PRESCHOOL
FACILITY NUMBER: 203808144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2023
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.
This requirement was not met evidence by: Based on record review provided by licensee indicating (ALE) of 13.000 ppb in outlet A and (ALE) of 6.500 in outlet B.
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Director agrees to submit evidence of replacement and remediation on outlet A and B testing at or below Action Level by POC due date 05/02/23. Director agrees to notify parents and guardians and post (ALE) results for 30 days at a reasonable location for Authorized Representatives to review as soon as possible.


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 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 MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Denisia JimenezTELEPHONE: (559) 767-0718
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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