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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616384
Report Date: 08/28/2023
Date Signed: 08/28/2023 12:16:34 PM


Document Has Been Signed on 08/28/2023 12:16 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:JAMES A. MCKEE ELEMENTARY SCHOOLFACILITY NUMBER:
343616384
ADMINISTRATOR:BRENDA JACKSONFACILITY TYPE:
850
ADDRESS:8701 HALVERSON DRIVETELEPHONE:
(916) 686-3715
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:24CENSUS: 18DATE:
08/28/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alma LopezTIME COMPLETED:
12:16 PM
NARRATIVE
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On 08/28/2023, Licensing Program Analyst (LPA) Jennie Tedlos and Licensing Program Manager Bettina Engelman conducted a case management inspection to follow-up on a water report with an exceedance of lead in 2 water outlets. LPA arrived at the Facility and was met by the Lead Teacher Substitute, Alma Lopez(T1). LPA disclosed the purpose of the inspection and was granted entrance into the Facility. LPA toured the facility and observed 18 children supervised by 4 staff members.
LPA was notified of the water testing report on 08/16/2023 via email. The testing revealed that 2 water outlets at the facility Sample D and Sample E, had elevated levels of lead. LPA observed that 2 water fountains, one inside the classroom and once outside in the playground area, have been covered with black plastic - and are inaccessible to use. One of these fountains had a sign directing people to the portable water source. A third fountain, located in the kitchen area, is not covered or labeled as inaccessible. T1 states that the water fountain is not being used for drinking or food preparation.. LPA is requesting to see the water testing report which indicates which 2 water outlets have the exceedances. Filtered water is being served to children from a water dispenser located in the classroom. T1 states that the water testing report would be obtained by the school's maintenance and operations and will be sent to LPA. LPA explained that the water outlets must be retested and cleared before being used. T1 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). CCC completed testing and is in the process of remediating lead exceedances. LPA referred T1 to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information .
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 T1. LPA provided T1 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: Bettina EngelmanTELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2023
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 08/28/2023 12:16 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: JAMES A. MCKEE ELEMENTARY SCHOOL
FACILITY NUMBER: 343616384

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2023
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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 Facility representative shalll send LPA current lead report indicating which fountains have exceedances & schedule re-testing. Facility shall post signage above all 3 water outlets stating they are not to be used for drinking, and send pictures of the signage to LPA.
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water report revealed that the facility had
elevated levels of lead in 2 water outlets, Samples D and E. There is no documentation indicating where these samples are. 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: Bettina EngelmanTELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2023
LIC809 (FAS) - (06/04)
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