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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801661
Report Date: 10/27/2022
Date Signed: 10/27/2022 12:23:06 PM


Document Has Been Signed on 10/27/2022 12:23 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:ST. CLEMENT'S DAY CARE CENTERFACILITY NUMBER:
543801661
ADMINISTRATOR:MASKAL-POWERS, RUTHFACILITY TYPE:
840
ADDRESS:498 NORTH VALENCIA BLVD.TELEPHONE:
(559) 564-8668
CITY:WOODLAKESTATE: CAZIP CODE:
93286
CAPACITY:14CENSUS: 22DATE:
10/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ruth Maskal-PowersTIME COMPLETED:
12:30 PM
NARRATIVE
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On 10/27/2022, Licensing Program Analysts (LPAs), Jose Penate and Daniel Alvarez conducted an unannounced case management inspection. LPA met with Director, Ruth Maskal-Powers who accompanied LPA on a tour of the facility, and a census was taken. The purpose of today’s inspection is to address a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) from water at the facility.

Fresno Regional Office received notification that the facility has very high lead exceedance from a water lead sampling test collected on 3/3/22. LPA reviewed the following Sampling Documents with Director: LIC 9275 - External Water Sampler Self-Certification Form, LIC 999 - Facility Sketch, and LIC 9276 - Child Care Center Sampling Checklist Form with Director to identify the outlets with ALE. LPA advised Director the following sample sites contained ALE: Outlet E in the playground with 5.66 ppb. LPA informed Director that the facility is out of compliance due to lead exceedance in the water fountain and due to not being tapped off for complete in-operability. LPA observed water outlet inoperable by shutting off the water values. LPA discussed with Director different options to bring the facility into compliance: permanently cease use of this outlet, replace the water outlet and conduct a Follow-up Corrective Action Water Sampling Test. Director stated she will permantely remove the water line. Director agrees to update the plan of operation with changes to the facility. Director shall notify all parents/authorized representatives of any corrective action already taken at the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D).

Director was provided a copy of appeal rights. An exit interview was conducted with the Director.

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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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 10/27/2022 12:23 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: ST. CLEMENT'S DAY CARE CENTER
FACILITY NUMBER: 543801661

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2022
Section Cited

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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 ... (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE). This requirement was not met as evidenced by:
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Based on record review, one outlet at the facility contained very high lead exceedance greater than 5.5 ppb. This poses a potential health, safety or personal rights risk to persons in care.
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Director will notify all parents/authorized representatives of any corrective action already taken at the facility. Director stated she will conduct a follow up with LPA on notification of parents on water sample as outlined in Written Directives Section 101705 and submit all required documentation to CCL by 11/11/22.

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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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
LIC809 (FAS) - (06/04)
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