<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525405800
Report Date: 10/18/2023
Date Signed: 10/18/2023 10:30:30 AM


Document Has Been Signed on 10/18/2023 10:30 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:LITTLE FRIENDS OF CAPAYFACILITY NUMBER:
525405800
ADMINISTRATOR:BROWN, TONIFACILITY TYPE:
850
ADDRESS:25490 MOLLER AVENUETELEPHONE:
(530) 865-2806
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:24CENSUS: 14DATE:
10/18/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrea - DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/18/2023 at 10:00am, Licensing Program Analyst (LPA) S. Sims made a case management inspection and met with Andrea Rivera. 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 faucets tested above the allowable level (5.5 ppb or greater) of lead in the water:

Faucet “A” – Front Kitchen Sink, 6.3ppb
Faucet “B” – Back Kitchen Sink, 8.5ppb

The Director has made the faucet(s) inaccessible by creating sign that say "hand wash only" and the sinks are in a locked kitchen inaccessible to children . The director plans to replace and retest the faucet. Children in care are receiving drinking water from filtered water bottle stations..

The following deficiency is being cited (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.

Exit interview conducted and report was reviewed with the director Andrea Rivera.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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 10/18/2023 10:30 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: LITTLE FRIENDS OF CAPAY
FACILITY NUMBER: 525405800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2023
Section Cited
HSC
101700.3(b)(2)

1
2
3
4
5
6
7
101700.3(b)(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.
1
2
3
4
5
6
7
The licensee has made the faucets temporarily inaccessible by hand wash only signs and locked door. The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on record review, the facility had 2 faucet(s) with lead test results exceeding 5 ppb of lead in the water. This is a potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2