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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407134
Report Date: 08/16/2023
Date Signed: 08/16/2023 01:20:20 PM


Document Has Been Signed on 08/16/2023 01:20 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:MONTESSORI CHILDREN'S HOUSE OF SHADY OAKSFACILITY NUMBER:
455407134
ADMINISTRATOR:HELART, JULIEFACILITY TYPE:
850
ADDRESS:1410 VICTOR AVE.TELEPHONE:
(530) 222-0355
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:85CENSUS: 64DATE:
08/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Julie HelartTIME COMPLETED:
01:25 PM
NARRATIVE
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On 8/16/2023 at 12:00pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with Licensee/Director Julie Helart. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucet tested above the allowable level (5.5 ppb or greater) of lead in the water:
Faucet “D” – Sink located in Room #1, 7.3 ppb

The licensee has made the faucet inaccessible by posting a sign over the faucet stating "For Hand Washing Only, Not For Drinking or Food Prep". The licensee plans to replace the supply lines and angle stops and retest the faucet. Children in care are receiving drinking water from water supplied by Faucet A located in the kitchen. Faucet A tested below the threshold of 5 ppb.

The following deficiency is being cited [101700.3(b)(2)], (see LIC 809D).

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with licensee Julie Helart.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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 08/16/2023 01:20 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: MONTESSORI CHILDREN'S HOUSE OF SHADY OAKS
FACILITY NUMBER: 455407134

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2023
Section Cited
CCR
101700.3(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.
This requirement was not met as evidenced by:
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The licensee has made the faucet temporarily inaccessible by The licensee has made the faucet inaccessible by posting a sign stating "For Hand Washing Only, Not For Drinking or Food Prep".

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Based on the record review, the facility had one faucet with lead test results exceeding 5 ppb of lead in the water. This is a potential health and safety risk to children in care.

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The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling.

CCR

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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
LIC809 (FAS) - (06/04)
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