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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390300406
Report Date: 09/19/2022
Date Signed: 09/19/2022 10:53:28 AM


Document Has Been Signed on 09/19/2022 10:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:LITTLE METHODIST PRE-SCHOOLFACILITY NUMBER:
390300406
ADMINISTRATOR:NATALIE KIESZFACILITY TYPE:
850
ADDRESS:200 WEST OAK STREETTELEPHONE:
(209) 368-5111
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:36CENSUS: 35DATE:
09/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Natalie KieszTIME COMPLETED:
11:00 AM
NARRATIVE
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On Monday, 09/19/2022, Licensing Program Analyst (LPA) Erwin Tjhia and Licensing Program Manager (LPM) Bettina Engelman met with Director, Natalie Kiesz for a Case Management inspection. The purpose of the inspection was to follow up on a recent report of the lead testing in the facility of the water used for drinking and cooking. Present in the facility were 9 staff supervising 35 children.

LPA was notified of the lead testing report on 09/07/2022 via email. The report revealed that 4 water outlets, A, B, D, and H had elevated levels of lead. Center Manager,Natalie Kiesz reported that the water line this water outlets have been turned off and is not allowed for use until all affected outlets can be replaced or repaired. Facility is using bottled water for dinking and any food preparation at outlets, A, B, and D. The water outlet H us is outside drinking fountain and turned off.

During today's inspection, LPA and LPM verified that the affected water outlet is not in use. The water fountain's faucet will be replaced with an approved low lead fixture by California licensed plumber. Following at least three week of conditioning, outlet will be retested according to the written directives.



As a result of the water testing positive for elevated lead levels, a deficiency was cited on subsequent page 809D.

An exit interview was conducted and the report was reviewed with Center Manager, Natalie Kiesz. Licensee Appeal Rights were provided. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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 09/19/2022 10:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: LITTLE METHODIST PRE-SCHOOL
FACILITY NUMBER: 390300406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2022
Section Cited

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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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 Lead test result received by CCLD on 09/07/2022, tested on 08/17/2022 had lead level exceeding 5 parts per billion in Outlets A, B, D & H. This is a potential health and safety risk to the children in care.
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Replacement has been ordered and Director shall notify LPA upon completion of replacement and re-testing.

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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) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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