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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406318
Report Date: 06/17/2025
Date Signed: 06/17/2025 09:29:01 AM

Document Has Been Signed on 06/17/2025 09:29 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 CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-LINCOLNFACILITY NUMBER:
100406318
ADMINISTRATOR/
DIRECTOR:		MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:651 B STREETTELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 7DATE:
06/17/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Teacher Xiomara MendozaTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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On 06/17/2025, Licensing Program Analyst (LPA) Xona Xayavong conducted an unannounced case management – lead testing/exceedance inspection. LPA met with Teacher Xiomara Mendoza. The purpose of the inspection was to follow up on Lead Sampling Report that was received by the Fresno Regional Office on 05/22/2025.

On 05/09/2025, Program Manager II Kim Beckwith received the lead sampling test report from All Hazard EHS. LPA observed the Playground Bubblers were located at the playground. The results were as follows: 100406318 A – Playground Bubbler Left: 1.18 ppb, 100406318 B – Playground Bubbler Center: <1.00 ppb,100406318 C – Playground Bubbler Right: 1.11 ppb, and 100406318 B30 – Playground Bubbler Center Flush: <1.00 ppb.

LPA also received the following documents from the report: LIC 9275 – External Water Sampler Self-Certification Form, LIC 9276 – Child Care Center Sampling Checklist Form, and LIC 999 – Facility Sketch.

Based on the lead sampling test report received on 05/09/2025, all results were below the action level of 5.5 ppb. Therefore, no further action is required at this time. Teacher Xiomara Mendoza is aware that outlets must be retested every five years to remain in compliance with the Written Directives.

(Continue on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Xona Xayavong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FUSD-LINCOLN
FACILITY NUMBER: 100406318
VISIT DATE: 06/17/2025
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As of 06/17/2025, the following outlets may be used to provide drinking water for children in care:100406318 A – Playground Bubbler Left, 100406318 B – Playground Bubbler Center, 100406318 C – Playground Bubbler Right, and 100406318 B30 – Playground Bubbler Center Flush.

Exit interview conducted and report was reviewed with Teacher Xiomara Mendoza. Appeal rights were provided.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, no deficiencies are cited. 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.

NAME OF LICENSING PROGRAM MANAGER: Kari McWilliams
NAME OF LICENSING PROGRAM ANALYST: Xona Xayavong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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