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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343602532
Report Date: 06/27/2023
Date Signed: 06/27/2023 11:05:04 AM


Document Has Been Signed on 06/27/2023 11:05 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:FAIRSITE PRESCHOOLFACILITY NUMBER:
343602532
ADMINISTRATOR:VALDOVINOS, VERONICAFACILITY TYPE:
850
ADDRESS:902 CAROLINE AVENUETELEPHONE:
(209) 745-2506
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:144CENSUS: 34DATE:
06/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kuljeet NajjarTIME COMPLETED:
11:00 AM
NARRATIVE
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On 06/27/2023, Licensing Program Analyst Katy Maestas (LPA) conducted a field visit to the Facility for the purpose of a case management inspection to follow-up on a water report with an exceedance of lead in 5 water outlets. LPA arrived at the Facility and was met by the Acting Director Kuljeet Najjar (D1). LPA disclosed the purpose of the inspection and was granted entrance into the Facility. LPA toured 3 classrooms which were open for the summer and observed 34 preschool aged children being supervised by 6 staff members.

LPA was notified of the water testing report on 05/23/2023 via email and required documentation was attached. The testing revealed that 5 water outlets in classrooms had elevated levels of lead. LPA observed that the water outlets have been marked as "closed" and are inaccessible for use. Filtered water is being served from a pitcher which is filled from an outlet which is not affected and or bottled water is served. D1 stated that the faucets had already been replaced, and LPA explained the water outlets must be re-tested before use of the outlets is resumed. D1 understands that the water report from the water re-test must be submitted to the Regional Office to remain in compliance.

As a result of the water testing for an exceedance of lead, a deficiency was cited on subsequent 809-D page. An exit interview was conducted and the report was reviewed with D1. LPA provided D1 with Licensee Appeal Rights. A Notice of Site was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.


SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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 06/27/2023 11:05 AM - 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: FAIRSITE PRESCHOOL
FACILITY NUMBER: 343602532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2023
Section Cited

101700.3(b)(1)

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Lead Testing (b)(1) A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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During today's visit, LPA observed that the affected water outlets are not in use. D1 will schedule re-testing and submit the water report to the RO to resume using these 5 water outlets. Deficiency will be cleared during today's visit.



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water report revealed that the facility had elevated levels of lead in 5 water outlets. This is a potential health and safety risk to the children 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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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