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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810047
Report Date: 05/26/2023
Date Signed: 05/26/2023 11:46:58 AM


Document Has Been Signed on 05/26/2023 11:46 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:OLIVE PS 255-PUSDFACILITY NUMBER:
543810047
ADMINISTRATOR:REBECCA ORTEGA-ORTIZFACILITY TYPE:
850
ADDRESS:255 OLIVE AVETELEPHONE:
(559) 782-7120
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:24CENSUS: 16DATE:
05/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ben Irizarry- Learning DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 5/26/23, Licensing Program Analyst Jessika Thompson conducted an unannounced case management inspection. LPA met with Ben Irizarry, Learning Director. The purpose of today's inspection was to address 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.

The Fresno South Regional Office received notification of a water lead exceedance at the facility resulting from a water lead sampling test collected on 3/23/23. Records were reviewed from BSK Associates and it has been determined that there is an exceedance in outlets (A) and (A-Flush) at the facility. LPA inspected outlet (A); it was observed to be a drinking faucet located within the classroom that was impacted with 5.5 ppb (ALE) of lead. LPA inspected outlet (A); it was observed to be a drinking faucet, also within the facility's classroom, that was impacted with 72 ppb (ALE) of lead. Licensee has made both faucets inoperable to preschool children by placing restrictive wrapping and signage on both faucets. Facility staff have been made aware that both faucets are not permitted for usage until water retesting and clearance. A Notification of lead exceedance information has been posted in pertinent areas of the facility.

The licensee ensures drinking water is readily accessible to children by utilizing outlet (B) for drinking purposes. Outlet (B) was also tested for lead on 3/23/23; reports reflect that outlet B is not impacted with a lead exceedance (see plan of correction for further corrective action LIC809D). Facility has notified all authorized representatives of the aforementioned corrective action.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC809D). Director was provided a copy of the appeal rights. An exit interview was conducted with 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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023
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 05/26/2023 11:46 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: OLIVE PS 255-PUSD
FACILITY NUMBER: 543810047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2023
Section Cited

101700.3(b)(1)

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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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Director has provided LPA with proof of replacement orders for affected faucets. Director stated that subsequent to installation of replacement faucets, facility will conduct daily flushing for three weeks. Thereafter, Director will ensure completion of a second water lead sampling test. Director to provide Community Care Licensing (CCL) with a copy of testing results.
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Based on record review, two outlets at the facility contained lead exceedances greater than 5.5 ppb. This poses a potential health, safety or personal rights risk to persons in care.
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Facility has notified all parents/authorized representatives of ALE, and of any corrective action already taken at the facility.

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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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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