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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490107830
Report Date: 01/06/2023
Date Signed: 01/06/2023 01:06:25 PM


Document Has Been Signed on 01/06/2023 01:06 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:BETHLEHEM CHILDREN'S CENTERFACILITY NUMBER:
490107830
ADMINISTRATOR:MC NALLY, DEBORAHFACILITY TYPE:
850
ADDRESS:1300 ST FRANCIS ROADTELEPHONE:
(707) 538-2266
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:85CENSUS: 26DATE:
01/06/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Deborah McNallyTIME COMPLETED:
01:15 PM
NARRATIVE
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On 01/06/23, Licensing Program Analyst (LPA), Amy Strother made a case management inspection and met with Director, Deborah McNally (D1). The inspection was made in response to water lead testing results received from the facility. The test results showed that the following water faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "D" the sink in the Penguin classroom had a reading of 5.5 parts per billion (ppb) and sample site “E” the sink in T-K classroom had a reading of 13 ppb. All other sources of water tested below the allowable level of 5.0 ppb. D1 stated both sink "D" and "E" are staff hand washing sinks and are not used for drinking or food preparation.

Upon notification on 12/7/22, the facility removed the faucets from service by wrapping them with a plastic bag and placing a sign on the faucet that reads, "Do Not Use”. The facility also posted the testing results for parents and authorized representatives, as required. Children in care are receiving drinking water from individual water bottles from home that staff refill from store bought bottled water, as needed. D1 stated that if a child does not bring a water bottle from home, the staff provide a disposable cup with bottled water.

LPA obtained the following documents from school Board President, Susan Jenkins (B1) via email on 12/07/22; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999). On 12/08/22 B1 emailed LPA Strother photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999), as required. During today's visit, D1 provided LPA with a letter that was given to families dated 12/08/22 informing them of the testing results.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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.

Exit interview conducted and report was reviewed with the Director, Deborah McNally.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
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 01/06/2023 01:06 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: BETHLEHEM CHILDREN'S CENTER
FACILITY NUMBER: 490107830

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2023
Section Cited

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101700.3(b)(1) A result with 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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LPA observed that the facility has temporarily removed the affected faucets “D” and “E” from service by way of a plastic bag cover and a sign that reads "Do Not Use". D1 stated that the facility plans to replace the faucets, flush them and retest. The facility will continue to inform families of the remediation steps.
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Based on record review, the facility had two faucets (Site “D” and Site “E”) that exceeded that allowable levels of lead in the water (5.5ppb and 13ppb). This is a potential health and safety risk to children in care.
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Children in care are receiving drinking water from individual water bottles from home that staff refill from store bought bottled water.

Send re-test results for Site "D" and "E" to amy.strother@dss.ca.gov

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
LIC809 (FAS) - (06/04)
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