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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570305772
Report Date: 09/19/2022
Date Signed: 09/19/2022 12:38:41 PM


Document Has Been Signed on 09/19/2022 12:38 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. PAUL'S LUTHERAN PRESCHOOLFACILITY NUMBER:
570305772
ADMINISTRATOR:JILL HARDINFACILITY TYPE:
850
ADDRESS:625 WEST GIBSON ROADTELEPHONE:
(530) 662-1935
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:46CENSUS: 4DATE:
09/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Director, Jill HardinTIME COMPLETED:
12:50 PM
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On September 19, 2022, LPA (Licensing Program Analyst) Lauren Scott met with Director, Jill Hardin, for the purpose of a Case Management inspection related to elevated levels of lead in the water.

The Regional Office was notified of the elevated levels of lead in the facility's water. While at the facility, LPA received a physical sketch of the facility with the faucet labels. LPA checked the faucet area where the exceedance occurred. This faucet is located in an area of the church property and not part of the licensed daycare facility. This area is an off limits area to children in care. Children have no access to this area. Director gave LPA copy of the lead testing report that showed no other exceedances within the facility. Due to the location and usage of the faucet, LPA determined there was no risk. Therefore, no citations will be issued at this time.

An exit interview was conducted and the report was reviewed with director, Jill Hardin, Licensee Appeal Rights were provided. A Notice of Site visit 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.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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