<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313614598
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:37:49 PM

Document Has Been Signed on 11/10/2022 02:37 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:STAR LINCOLN CROSSINGFACILITY NUMBER:
313614598
ADMINISTRATOR:RACHEL PETERSFACILITY TYPE:
840
ADDRESS:635 GROVELAND LANETELEPHONE:
(916) 409-0797
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 250TOTAL ENROLLED CHILDREN: 250CENSUS: 15DATE:
11/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rachel PetersTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Blesi and Gallo met with the facility representative, Rachel Peters, for a case management inspection. The purpose of the inspection was to discuss the lead in facility water report. There were four staff supervising 15 school age children today.

During today's inspection, LPAs discussed the report with the facility representative. LPA explained to the facility representative that all faucets that are used for drinking or cooking, must have less than 5.5 PPB lead. The facility had water tested on October 5, 2022 and it was found that the drinking fountains inside the classroom tested for 27 PPB. The facility representative stated that the facility has turned off the water to the drinking fountains, taped a plastic bag over the faucet and now supplies bottled water for the children to drink. LPA observed the fountains in the classroom, which exceeded the requirement and there were plastic bags and tape covering the spouts. Staff have placed a sign above the fountain stating "out of order".

See next page LIC 809-D for deficiency cited today.

Copy of this report was reviewed and provided to the facility representative, Rachel Peters. Notice of site visit is posted and shall remain posted for next 30 days.
Keven Peters
Amanda Blesi
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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 11/10/2022 02:37 PM - It Cannot Be Edited


Created By: Amanda Blesi On 11/10/2022 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: STAR LINCOLN CROSSING
FACILITY NUMBER: 313614598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

1
2
3
4
5
6
7
California Lead Action Level at Child Care Centers. 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. This requirement was not
8
9
10
11
12
13
14
met as evidenced by based on results of a test conducted on a drinking fountain on October 5, 2022 indicated 27 PPB which exceed 5.5 ppb requirement. This is a potential risk to the health and safety of children in care
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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:Keven Peters
TELEPHONE:
LICENSING EVALUATOR NAME:Amanda Blesi
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2