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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805816
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:55:19 AM


Document Has Been Signed on 11/16/2023 10:55 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LIFE CHRISTIAN ACADEMYFACILITY NUMBER:
334805816
ADMINISTRATOR:KIMBERLY FREDERIQUEFACILITY TYPE:
850
ADDRESS:3270 RUBIDOUX BLVD.TELEPHONE:
(951) 684-3639
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:60CENSUS: 13DATE:
11/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:KIMBERLY FREDERIQUETIME COMPLETED:
11:05 AM
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
Due to required lead testing requirements, Licensing Program Analysts (LPAs), Aman Sharma and Justin Giese conducted a Case Management inspection based on lead testing results received on the facility. LPAs toured the facility, took census and met with Director, Kimberly Frederique to further discuss lead results received and measures taken for remediation of lead exceedances.

During the inspection, LPAs toured and obtained photos of the following water outlets identified with lead exceedances: Outlet A (9.4 ppb) located in the administrative office, used for an isolation room during the time a child is showing signs of illness. The faucet in outlet A is not a drinking faucet and water is not used for water consumption, and only utilized for hand washing. LPAs observed required signage posted at outlets for cessation of use.

Facility implemented remediation via faucet change and will be re-tested. Director has covered water outlet A and posted signage for non use. Facility is currently in process for remediation. LPA observed notification of lead results posted at the facility front reception.

Facility has access to additional water resources: children bring their own water bottles from home and are offered water bottles from the facility.

Due to facility water outlets not being a drinking water facet, there are no citations during todays inspection.


Additionally, the following resources were discussed and provided: PIN 21-21.1-CCP dated December 28, 2022.

An exit interview was conducted, and appeal rights were discussed. LPAs Sharma and Giese provided Director, Kimberly Frederique with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for the next three years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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 1