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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808169
Report Date: 01/23/2023
Date Signed: 01/23/2023 01:14:50 PM


Document Has Been Signed on 01/23/2023 01:14 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:AILEEN COLBURN PRESCHOOLFACILITY NUMBER:
243808169
ADMINISTRATOR:LAMERSON, LINDAFACILITY TYPE:
850
ADDRESS:2201 HELLER AVENUETELEPHONE:
(209) 357-6136
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:48CENSUS: 23DATE:
01/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Assistant Teacher, Hope RamirezTIME COMPLETED:
01:30 PM
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On 01/23/2023, Licensing Program Analyst (LPA) Ka Vang conducted an unannounced case management inspection. LPA met with Teacher who accompanied LPA on a tour of the facility. This facility has two separate classrooms, one classroom identified as Classroom 8, and the other classroom identified as Classroom 3. Both classes, including the AM and PM sessions, accounts for the license capacity of 48 children. Census was taken and there are 23 children present during today’s inspection. 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) in the water at the facility.

Fresno Regional Office received notification that the facility has a high lead exceedance from a recent water lead sampling test collected on 12/16/2022. Based on records reviewed from the Environmental Laboratory Accreditation Program (ELAP) report, and self-reported information for Aileen Colburn Preschool (LIC #: 243808169), the water fountain in the Classroom 3 (IL16023-06), Classroom 3 (IL16023-07) and Classroom 8 (IL16023-08) had a result over the ALE of 5.5 ppb. Based on the incident report submitted and LPA's observation, the facility has made the outlet inoperable, and is in the planning stages of repairing the outlet. The facility is providing alternative potable water via bottle water in Classroom 3 and Classroom 8 to children, visitors, and staff during hours of operation

Per PIN 21-21 CCP WD 101704 (b)(3), 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. Licensee submitted the following documents along with the incident report: Facility Sketch (LIC 999) for both indoor and outdoor areas, Child Care Center Sampling Checklist form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275), Lead testing results for the facility, from LA Testing, Pictures of faucets/fountains being tested. The facility has agreed to continue with the re-sampling process for an action level result of under 5.5 ppb for compliance.

(Continued on LIC809-C).

SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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 3


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: AILEEN COLBURN PRESCHOOL
FACILITY NUMBER: 243808169
VISIT DATE: 01/23/2023
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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). Teacher was provided a copy of appeal rights. An exit interview was conducted with the Teacher.

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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/23/2023 01:14 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: AILEEN COLBURN PRESCHOOL
FACILITY NUMBER: 243808169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2023
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 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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Teacher agrees to submit evidence of remediation on outlet Classroom 3 (IL16023-06), Classroom 3 (IL16023-07) and Classroom 8 (IL16023-08) at or below Action Level by Plan of Correction date 02/20/2023 (30 days). Site Supervisor has notified and posted ALE results at a reasonable location for Authorized Representatives to review.
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 This requirement was not met evidence by based on record review provided by Licensee, Classroom 3 (IL16023-06), Classroom 3 (IL16023-07) and Classroom 8 (IL16023-08) has a result indicating 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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Ka VangTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
LIC809 (FAS) - (06/04)
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