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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570300647
Report Date: 05/01/2023
Date Signed: 05/01/2023 03:33:29 PM


Document Has Been Signed on 05/01/2023 03:33 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:ST. LUKE'S PRESCHOOLFACILITY NUMBER:
570300647
ADMINISTRATOR:LAURIE MOOREFACILITY TYPE:
850
ADDRESS:515 SECOND STREETTELEPHONE:
(530) 662-1853
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:44CENSUS: 20DATE:
05/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:lead teacher, Alexa LoveTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lauren Scott met with lead teacher, Alexa Love, for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report received by CCLD.

LPA was notified of the lead testing report on 04/17/2023. The report revealed that one water outlets had elevated levels of lead. Director had previously stated to LPA that the fountain had not been used since March 2020 when they were taped off and made inaccessible for use due to COVID-19.

During today's inspection, LPA verified that the affected water outlet is still not in use. Director had stated that she is in the process of removing the fountain completely and will notify LPA once the date of removal is confirmed. Children have been bringing their own water bottles since reopening in 2020 and will continue to do so. Facility is refilling the water bottles with bottled water provided by facility.

As a result of the water testing positive for lead, a deficiency was cited on a subsequent page, 809D.

An exit interview was conducted and the report was reviewed with lead teacher, Alexa Love. A Notice of Site was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2023
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 05/01/2023 03:33 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: ST. LUKE'S PRESCHOOL
FACILITY NUMBER: 570300647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2023
Section Cited

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Lead Testing (b)(1) A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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During today's visit LPA observed that the affected water outlets are not in use and have been taped off since 2020. Director stated the faucet is to be permanently remvoed.
Deficiency will be cleared during visit.
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The water report revealed that the facility had elevated levels of lead in one water fountain. This is a potential health and safety risk to the children 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: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2023
LIC809 (FAS) - (06/04)
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