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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405710
Report Date: 01/13/2023
Date Signed: 01/13/2023 01:16:49 PM


Document Has Been Signed on 01/13/2023 01:16 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:FAIRVIEW VILLAGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
540405710
ADMINISTRATOR:CHRISTINA HANGERFACILITY TYPE:
850
ADDRESS:2645 N. CONYER STREETTELEPHONE:
(559) 627-2296
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:44CENSUS: 31DATE:
01/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jatinder KaurTIME COMPLETED:
01:30 PM
NARRATIVE
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On January 13, 2023 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management inspection. LPA McWilliams met with Lead Teacher Jatinder Kaur. The purpose of today’s inspection was to conduct a case management inspection and to notify the facility that there has been 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. LPA conducted a tour of the facility inside and out and a census was taken.

Fresno South Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from Dellavalle Laboratory Inc. and discussions with Lead Teacher Kaur it has been determined that there is an exceedance to outlet E in the facility. LPA McWilliams inspected outlet E it was observed to be a sink in the kitchen that was impacted with 33 ppb(ALE) of lead. Lead Teacher, has discontinued the use of outlet E by; replacing the faucet and is in the process of flushing the new fixture. There is a sign stating "do not use until further notice" and a form of times and signatures of who is flushing the faucet.

(See plan of correction for further corrective action 809D). Lead Teacher Kaur has notified authorized representatives of this corrective action in both languages; English and Spanish.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809D). Lead Teacher Kaur were provided a copy of the appeal rights. An exit interview was conducted with Lead Teacher Kaur.

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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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 01/13/2023 01:16 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: FAIRVIEW VILLAGE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 540405710

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited

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(a)California’s Action Level for lead in water at Child Care Centers is 5ppb.(b) Testing results with fractional ppb readings of 0.5ppb or greater shall be rounded up to the nearest whole number... (1) A result with values of 5.5ppb or greater ...
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LPA observed the posting of the results, letter to represenatives, observed the outlet with a sign of "do not use until further notice", and action plan of the facility. Lead Teacher Kaur stated that the outlet E will be retested after flushing and the results will be sent to LPA.
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This requirement was not met by evidence by: Based on record review provided by Dellavalle Laboratory Inc.,a result of (ALE) of 33ppb for outlet E which is out of compliance over the allowable ALE 5.5ppb. This 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: Luisa GavoutianTELEPHONE: (559) 650-7879
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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