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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406442
Report Date: 12/06/2022
Date Signed: 12/06/2022 09:20:02 AM

Document Has Been Signed on 12/06/2022 09:20 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-WINCHELLFACILITY NUMBER:
100406442
ADMINISTRATOR:MADDEN, KATHERINEFACILITY TYPE:
850
ADDRESS:3722 E. LOWETELEPHONE:
(559) 457-3690
CITY:FRESNOSTATE: CAZIP CODE:
93702
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 11DATE:
12/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Jandalynn GutierrezTIME COMPLETED:
09:35 AM
NARRATIVE
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On 12/6/2022 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with Teacher, Jandalynn Gutierrez for the purpose of conducting a case management inspection, regarding a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from the LA testing report and self reported information for FUSD - Winchell # 100406422 impacted with an ALE of 6.87 ppb in (outlet F, room 11, High Faucet). This result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Outlet has temporarily been made inoperable as the water has been shut off to the faucet. Repairs will be made and the outlet will be resampled for an action level result of under 5.5 ppb for compliance with a Certified Sampler.

Teacher stated that some children bring in their own water bottles from home. Children are able to refill them by means of alternative potable water source that is in compliance. In the event preschool children do not bring a water bottle fresh potable water is available by means of a water jug and cups . Potable water is also made available to visitors and staff during hours of operation. Facility also posted results for parents to review Per PIN 21-21 CCP WD 101703 (b). In addition parents and guardians have been notified of the (ALE ) Per PIN 21-21 CCP WD 101704 (b)(3) threw a letter.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809 D). Teacher was provided a copy of appeal rights. An exit interview was conducted. 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.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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Document Has Been Signed on 12/06/2022 09:20 AM - It Cannot Be Edited


Created By: Caroline Harris On 12/06/2022 at 09:01 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FUSD-WINCHELL
FACILITY NUMBER: 100406442

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2023
Section Cited

101700.3(a)(b)(1)(c)

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California Lead Action Level at Child Care Centers (a) California’s Action Level for lead in water at Child Care Centers is 5 ppb. (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
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The facility agrees to submit evidence of remediation on outlet F Faucet in Room 11 testing at or below Action Level by 30 days POC due date 01/06/23.
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This requirement was not met evidence by: Based on record review provided by LA Testing indicating (ALE) of 6.87 ppb in outlet F in Room 11. These results indicate out of compliance over (ALE) 5.5 ppb, which poses a potential health, safety or personal rights risk to persons in care.
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The teacher has notified parents and guardians via a letter and posted (ALE) results at a reasonable location for Authorized Representatives to review.

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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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022


LIC809 (FAS) - (06/04)
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