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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621220
Report Date: 01/20/2023
Date Signed: 02/02/2023 03:20:42 PM


Document Has Been Signed on 02/02/2023 03:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:KING'S CHILDREN'S ACADEMYFACILITY NUMBER:
343621220
ADMINISTRATOR:KING, JOSETTEFACILITY TYPE:
830
ADDRESS:2635 EDISON AVENUETELEPHONE:
(916) 993-6510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 1DATE:
01/20/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Josette KingTIME COMPLETED:
01:40 PM
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At 12:50 p.m. on Friday, January 20th, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Josette King, for the purpose of an unannounced case management - lead testing/exceedance inspection. LPA observed a census of 1 infant child supervised by 1 staff.

During today’s inspection, LPA followed up regarding water sampling that indicated an Action Level Exceedance (ALE) for a water faucet that was tested for lead levels. Faucet C was in lead level exceedance. LPA observed the faucet and took photo documentation. Licensee stated that the sink is not used for drinking nor cooking purposes and is for hand and dish washing only. Licensee provided documentation to parents to notify of the exceedance and corrective action. Licensee stated that drinking water is provided to children via filtered water from the main kitchen in the preschool facility, or from bottled water.

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

No deficiencies were cited today. LPA reviewed this report with the Licensee and conducted an exit interview. A Notice of Site Visit was provided and shall remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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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