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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604339
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:47:39 PM


Document Has Been Signed on 04/25/2024 01:47 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SHINING STARS AT CREEKSIDEFACILITY NUMBER:
343604339
ADMINISTRATOR:STEPHANIE PAIGEFACILITY TYPE:
850
ADDRESS:8939 E. STOCKTON BLVD.TELEPHONE:
(916) 714-0735
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:140CENSUS: 48DATE:
04/25/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Stephanie PaigeTIME COMPLETED:
02:05 PM
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On 04/25/24, Licensing Program Analyst (LPA) Jennie Tedlos conducted 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 Director, Stephanie Paige (D1). LPA disclosed the purpose of the inspection and was granted entrance into the Facility. LPA toured the facility and observed 48 children supervised by 8 staff members.

LPA was notified of the water testing report on 04/19/24 via email and required documentation was attached. The testing revealed that 3 water outlets in classrooms, and 2 water outlets in the kitchen tested for elevated levels of lead. LPA observed that the 3 drinking water fountains in the affected classrooms have been removed and taped over, rendering them inaccessible for use. There are also displayed signs at the sinks that state "This faucet is for hand washing only, not for water or food preparation. Thank you". The 2 sinks in the kitchen have signage taped on the faucet stating "Please do not use".Children bring their own water bottles which are filled with a pitcher from a water source at the facility that is not effected by the lead exceedance. D1 states that some of the water outlets have been fixed but is waiting for the other outlets to be fixed before scheduling a retest. LPA explained that the water outlets must be retested and cleared before being used. D1 understands that the water report from the retest must be submitted to the Regional Office to remain in compliance.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). This facility has COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES

Report Continues on 809-C...

SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHINING STARS AT CREEKSIDE
FACILITY NUMBER: 343604339
VISIT DATE: 04/25/2024
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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 Director, Stephanie Paige. 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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/25/2024 01:47 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: SHINING STARS AT CREEKSIDE
FACILITY NUMBER: 343604339

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
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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The Lead Testing Result Summary revealed that the facility had elevated levels of lead in 5 water outlets, Samples K, M, T, AA, BB. 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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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