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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343607711
Report Date: 01/23/2023
Date Signed: 01/23/2023 12:27:10 PM


Document Has Been Signed on 01/23/2023 12:27 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:KINDERCARE LEARNING CENTER - NATOMA (INF)FACILITY NUMBER:
343607711
ADMINISTRATOR:SANDHU, PARVEENFACILITY TYPE:
830
ADDRESS:420 NATOMA STATION DR.TELEPHONE:
(916) 353-0687
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:32CENSUS: 19DATE:
01/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jeanie YangTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst Jennifer Velasco (LPA) met with Facility Representative Jeanie Yang (D1) for an unannounced case management inspection regarding lead testing.

During today's inspection, there was a census of 19 children being supervised by five classroom staff. The purpose of today’s inspection was to create a plan of correction following reports of lead exceedance in one of the facility outlets.

On 12/17/2022, the facility had lead testing conducted using water samples from facility outlets. Lead testing identified one water outlet that has an Action Level Exceedance (ALE) over the amount of 5.5 parts per billion (ppb). The water outlet identified as "L" tested with an ALE of 5.95 ppb.

D1 stated water outlet L is no longer in use. LPA observed outlet L to be rendered inaccessible by use of plastic sheeting affixed to the outlet. The plastic sheeting had affixed to it a sign: "OUT OF SERVICE DO NOT USE." D1 stated the classroom is not in use and will not be in use until the outlet has been retested and is no longer in exceedance.

Alternative drinking water has been provided to the children through a drinking fountain in the classroom to which children were removed, and children bring their own water bottles.

LPA informed the Facility Representative that Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP.

Deficiency cited on the following page and is considered a a potential threat to the health and safety of children in care if not corrected. LPA reviewed this report with the Facility Representative and conducted an exit interview. Appeal Rights were provided. A Notice of Site Visit were provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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 01/23/2023 12:27 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: KINDERCARE LEARNING CENTER - NATOMA (INF)
FACILITY NUMBER: 343607711

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) ... "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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Facility Representative (D1) stated usage of the faucets was stopped upon receipt of testing results. Facility will use a different classroom with a water outlet that tested within requirements. inaccessible until they have been repaired or replaced and meet
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Based on record review, one water outlet tested exceeded the allowed 5.5 ppb, which poses a potential health, safety, or personal rights risk to children in care.
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health and safety requirements. D1 stated the facility will email to LPA all required documents at
jennifer.velasco@dss.ca.gov

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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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
LIC809 (FAS) - (06/04)
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