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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500308706
Report Date: 11/14/2022
Date Signed: 11/14/2022 11:07:38 AM


Document Has Been Signed on 11/14/2022 11:07 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:EVERETT CHILD DEVELOPMENT CENTERSFACILITY NUMBER:
500308706
ADMINISTRATOR:NUNES, HEIDIFACILITY TYPE:
850
ADDRESS:1530 MT VERNON DRTELEPHONE:
(209) 574-1992
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 14DATE:
11/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Kimbra Draper TIME COMPLETED:
11:30 AM
NARRATIVE
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On 11/14/2022 Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management inspection. LPA met with Kimbra Draper, ECE Coordinator. Purpose of today's inspection is to conduct a case management inspection regarding a water lead exceedance referred to as Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the drinking water at Everett Child Development Center.
Fresno Regional Office received notification of Action Level Exceedance (ALE) at the facility resulting from a recent water lead sampling test. Based on findings from Forensic Analytical Consulting Services reported outlet C to have an (ALE) of 100 ppb in classroom 18 located in an area designated for children exhibiting sickness symptoms. Outlet C was out of compliance for an unknown time frame. (See 809 D for further.) Potable water from the kitchen faucets was made available to preschool children during the repair process. Authorized representatives were notified of the Action Level Exceedance at the facility.

LPA Gibson consulted with Aaron Castro and confirmed the facility has completed the WD 101705 Follow up Corrective Action Water Sampling process and was able to provide evidence of fixture testing under 5.5 parts per billion (ppb).

Per Directives in PIN21-21 CP WD 101700.3 California Action Level at Child Care Centers. (b)Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required. A plan of correction Type B citation was issued to ensure the safety and well-being of children, employees and visitors.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809 D). An exit interview was conducted and appeal rights provided to Kimbra Draper, ECE Coordinator. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
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 11/14/2022 11:07 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: EVERETT CHILD DEVELOPMENT CENTERS
FACILITY NUMBER: 500308706

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2022
Section Cited

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101700.3 California Action Level at Child Care Centers. (b)Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required
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This requirement was not met evidence by: Based on record review provided by Forensic Analytical Consulting Services outlet C in classroom 18 was impacted with an (ALE) lead result of 100 ppb by Certified Lead Sampler. Result is over allowable Action Level of 5.5 ppb.


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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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
LIC809 (FAS) - (06/04)
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