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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390305456
Report Date: 08/31/2022
Date Signed: 08/31/2022 11:14:34 AM


Document Has Been Signed on 08/31/2022 11:14 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:ST. PAUL'S UNITED METHODIST PRESCHOOLFACILITY NUMBER:
390305456
ADMINISTRATOR:BERRY, BELINDAFACILITY TYPE:
850
ADDRESS:910 EAST NORTH STREETTELEPHONE:
(209) 239-5848
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:68CENSUS: 47DATE:
08/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Belinda Berry TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst Mariya Melnichuk and LPM Bettina Engelman met with Director Belinda Berry to follow up on Lead testing results. LPA received an emailed report of lead testing results from Director Belinda on 8/30/2022. During today's visit the facility was toured. Present were a total of 47 children. The sink in the Dove room and in the office had exceeded levels of lead. The Dove room results were 14 ug/L. The office sink results were 11 ug/L. Testing levels of 4.5ug/L and over are considered an action level exceedance.

LPA and LPM discussed an action plan for lead exceedance in the two areas. The sink in the office is not used for drinking or cooking. The sink in the Dove classroom has been used only for handwashing, and will be shut off today and replaced. Facility evaluation report was reviewed and discussed with Site Supervisor. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, a deficiency was observed at the time of the visit and cited on LIC 809D. An exit interview was conducted, and report was reviewed with Director Berry, who stated she understands todays inspection. Notice of Site Visit posted, and director understands it must remain posted for 30 days.

Appeal rights given.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Mariya MelnichukTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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 08/31/2022 11:14 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: ST. PAUL'S UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 390305456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited

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(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement was not met as evidenced by:
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An 8/18/2022 Lead Testing report indicated that outlet B (Sink in Dove Room) and D (Sink in Office) showed lead level exceedances in the water testing.
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Director stated that Outlet D, the sink in the Preschool Office, has not been used for drinking water or food preparation.

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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: Mariya MelnichukTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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