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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090320884
Report Date: 03/10/2023
Date Signed: 03/10/2023 10:00:38 AM

Document Has Been Signed on 03/10/2023 10:00 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:EL DORADO COUNTY FEDERATED CHURCH PRESCHOOLFACILITY NUMBER:
090320884
ADMINISTRATOR:REEVES,KELLYFACILITY TYPE:
850
ADDRESS:1031 THOMPSON WYTELEPHONE:
(530) 622-5226
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: DATE:
03/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kelly ReevesTIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Soleil Marx and Michelle Pascual met with Director Kelly Reeves to conduct an unannounced case management inspection regarding lead testing. During today's inspection there was a census of 25 preschool children being supervised by 6 staff. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in one of the facility outlets.

On 1/31/2023, the facility tested water samples for lead. The Lead Testing identified that a water outlet has a Lead Exceedance over the amount of 5.5ppb. The water outlet sampled is marked B, which is the sink/faucet located in room 4, which has an exceedance level of 11ppb.

Usage of the faucets was stopped immediately upon receiving the results, and a water jug filled in kitchen is now being used a source for water. The facility replaced the cold-water angle stop and supply line to the sink/faucet for room #4 (or B as labeled), however the sink still did not pass. The facility has an appointment with the lead testers to find out what further corrections need to be made. As soon as the facility knows when they can fix the issue and when they can get the faucet re-tested, they will inform LPA prior to use.



Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected.

An exit interview was conducted with the Director. LPA provided Director with Appeal Rights. A Notice of Site Visit was provided and must be posted for 30 days along with the lead results for parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023
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 03/10/2023 10:00 AM - It Cannot Be Edited


Created By: Soleil Marx On 03/10/2023 at 09:49 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: EL DORADO COUNTY FEDERATED CHURCH PRESCHOOL
FACILITY NUMBER: 090320884

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Usage of the faucets was stopped immediately upon receiving the results.Facility is using water jugs filled in the kitchen, as an alternate water source. Director stated they are going to make corrections to the sink and re-test. Director will inform LPA prior to use.
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Based on record review, one water outlet tested exceeded the allowed 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2023


LIC809 (FAS) - (06/04)
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