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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585402247
Report Date: 08/28/2023
Date Signed: 09/22/2023 03:58:32 PM

Document Has Been Signed on 09/22/2023 03:58 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:LONE TREE STATE PRESCHOOLFACILITY NUMBER:
585402247
ADMINISTRATOR:GUENSLER, CRAIGFACILITY TYPE:
850
ADDRESS:123 CAMP BEALE HWYTELEPHONE:
(530) 788-7658
CITY:BEALE AFBSTATE: CAZIP CODE:
95903
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 0DATE:
08/28/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nichole Steenberg, Administrative Assistant TIME COMPLETED:
12:00 PM
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This report is amended to reflect the correct exceedances.

On 8/28/23 at 11:00am, Licensing Program Analyst (LPA) E. Laird made a case management inspection and met with Nichole Steenberg. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water:

Faucet "D"-Classroom #33 Sink, 7.12ppb

The licensee has made the faucet(s) inaccessible by . The licensee replaced faucets over the summer break and retested all faucets on 8/23/23. Children in care are receiving drinking water from water bottles.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Nichole Steenberg.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Erica Laird
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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 08/28/2023 11:58 AM - It Cannot Be Edited


Created By: Erica Laird On 08/28/2023 at 11:18 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: LONE TREE STATE PRESCHOOL
FACILITY NUMBER: 585402247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2023
Section Cited

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101700.3(b)(2) Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.
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This requirement was not met as evidenced by:
Based on record review, the facility had faucet(s) with lead test results exceeding 5 ppb of lead in the water. This is a potential health and safety risk to 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:Megan Aviles
LICENSING EVALUATOR NAME:Erica Laird
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2023


LIC809 (FAS) - (06/04)
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