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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500319400
Report Date: 08/30/2023
Date Signed: 08/30/2023 10:50:52 AM


Document Has Been Signed on 08/30/2023 10:50 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:WATERFORD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
500319400
ADMINISTRATOR:CALLAHAN, DIANEFACILITY TYPE:
850
ADDRESS:219 N REINWAY AVETELEPHONE:
(209) 874-3301
CITY:WATERFORDSTATE: CAZIP CODE:
95386
CAPACITY:48CENSUS: DATE:
08/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Diane CallahanTIME COMPLETED:
11:30 AM
NARRATIVE
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On 08/30/23, Licensing Program Analysts (LPA) Anita Tristan and Valerie Mireles conducted an unannounced Case Management Inspection for Lead. LPAs met with Diane Callahan, Directo,r for the purpose of conducting a case management inspection, regarding a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility. Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from Child Care Center Lead Sampling and Reporting Tool and self-reported information to licensee #500319400 an outlet is impacted with an (ALE) of 6.8 ppb in the outdoor sink named outlet Q. This result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Outlet was capped off and is no longer able to be used. Director agrees to continue with the resampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler. Director stated children are provided water from outdoor sink (sink R) that was tested and had no exceedances.

Facility will post results for parents to review Per PIN 21-21-1 CCP WD 101703 (b). In addition, parents and guardians will be by letter and verbally of the (ALE) Per PIN 21-21-1 CCP WD 101704 (b)(3).

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 with Director, Diane Callahan, and a copy of the appeal rights were provided and discussed. This report shall be made available to the public upon request.

Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
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 08/30/2023 10:50 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: WATERFORD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 500319400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2023
Section Cited

101700.3

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(a) California’s Action Level for lead in water at Child Care Centers is 5 ppb. (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. Testing results with fractional ppb readings of less than 0.5 ppb shall be rounded. down 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. (2) 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. (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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Director had outlet Q capped off and the outlet is no longer able to be used. Director agrees to notified parents and guardians and
posted (ALE) results at a reasonable location by POC due date of 9/13/2023.
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This requirement was not met evidence by:
Based on record review provided by licensee indicating (ALE) of 6.8 ppb in outlet Q These results indicate out of compliance over (ALE) 5.5 ppb, which poses a potential health, safety or personal rights risk to persons in care.
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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: Cynthia BrannonTELEPHONE: (559) 650-7884
LICENSING EVALUATOR NAME: Anita TristanTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
LIC809 (FAS) - (06/04)
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