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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340302706
Report Date: 06/28/2023
Date Signed: 06/28/2023 04:09:35 PM


Document Has Been Signed on 06/28/2023 04:09 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:TRINITY TOTSFACILITY NUMBER:
340302706
ADMINISTRATOR:SANDRA ANDERSONFACILITY TYPE:
850
ADDRESS:5225 HILLSDALE BLVD.TELEPHONE:
(916) 331-7377
CITY:SACRAMENTOSTATE: CAZIP CODE:
95842
CAPACITY:153CENSUS: 19DATE:
06/28/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sandra AndersonTIME COMPLETED:
04:15 PM
NARRATIVE
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On Wednesday, June 28, 2023, Licensing Program Analysts (LPA) Amanda Sutter and Pa Dao Vang met with Director Sandra Anderson for an unannounced Case Management Inspection. LPAs observed 19 children supervised by 4 staff.

On 12/17/2022, the facility tested water samples for lead. Three outlets water sampled indicated an Action Level Exceedance (ALE) of 5 parts per billion. These outlets are marked C, J, and G on the facility sketch provided by the center. “C” correlates to the north-most tap in room 103, “J” correlates to the north-most tap in room 106, and "G" correlates to the east-most tap in room 107. On 1/3/2023, the facility was notified of ALEs in the locations listed. In an email on 1/10/2023, the facility was notified by the water tester that only taps D, H, and J were in exceedance. Director stated that because of this email she believed that the ALEs for C and G were incorrect, and that instead D and H had an ALE. Results uploaded to the drinking water database on 6/15/2023 show that taps C, J, and G were in exceedance.

Since notification, facility has replaced taps and valves D, H, and J. The taps have not yet been retested. Taps that tested in an ALE are still labeled in each classroom so that each staff is aware that they are for hand washing only. All classroom drinking fountains have been capped off. Water is provided to children through use of personal water bottles, which are filled at the children’s homes. Water bottles are filled at taps that did not test in exceedance, or bottled water is provided to children if necessary. During a case management inspection on 6/19/2023, Director stated that she wishes to remove room 103 from her license.

LPAs informed Site Supervisor that Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP. One type B deficiency is cited on the following page of the report. LPAs reviewed this report with the Director conducted an exit interview. Appeal rights were provided. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2023 04:09 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: TRINITY TOTS
FACILITY NUMBER: 340302706

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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LPA observed replaced taps for sites D, H, and J. Director stated that she will replace tap G, and will re-test all taps in exceedance. Tap C is located in room 103, which is to be removed from the license. Director will submit application showing that room 103 is no longer on license.
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Based on record review, three faucets tested exceeded the allowed 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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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