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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801894
Report Date: 09/29/2022
Date Signed: 09/29/2022 09:24:57 AM

Document Has Been Signed on 09/29/2022 09:24 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:SHINING STAR PRESCHOOL, NORTHWEST CHURCHFACILITY NUMBER:
103801894
ADMINISTRATOR:COX, DENISEFACILITY TYPE:
850
ADDRESS:5415 N. WESTTELEPHONE:
(559) 435-0349
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 130TOTAL ENROLLED CHILDREN: 130CENSUS: 103DATE:
09/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Denise CoxTIME COMPLETED:
09:40 AM
NARRATIVE
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On 09/29/22 Licensing Program Analyst (LPA) Caroline Harris conducted an unannounced case management inspection. LPA met with Denise Cox. The purpose of today's inspection is to discuss the lead exceedance, referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

The Fresno Regional Office, Community Care Licensing, received notification of water lead exceedance at the facility resulting from a recent water lead sampling testing. Records were reviewed from Enthalpy Analytical with director, Denise Cox, and LPA inspected outlets in rooms 115 ID I (9.3 ppb), room 114 ID H (9.1 ppb), room 113 ID G (6.5 ppb), room 110 ID A (8.0 ppb), and room 112 ID C (9.2 ppb). There were no drinking fountains in rooms 114 and 115, and the water was turned off under the sinks in rooms 110, 112 and 113. Ms. Cox reported that water for drinking and food preparation immediately stopped in the above mentioned rooms and the LPA observed signs posted over the sinks, "Do not use for drinking or food prep. Hand Washing Only". An IGLOO with water from the kitchen is also available to children, as an alternative water source and so the children's water bottles, that they bring from home, can be refilled. (See Plan of correction for further corrective action 809D). Parents or authorized representatives were further e-mailed the lead testing results.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). An exit interview was conducted with Denise Cox and she was provided a copy of this report, along with appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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 09/29/2022 09:24 AM - It Cannot Be Edited


Created By: Caroline Harris On 09/28/2022 at 01:49 PM
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: SHINING STAR PRESCHOOL, NORTHWEST CHURCH
FACILITY NUMBER: 103801894

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited

101700.3

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101700.3 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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Authorized representatives have been notified. The licensee stated that they plan to replace the fixtures that have the exceedance and have outlets resampled by a certififed sampler.
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This requirement was not met evidence by: Based on record review provided by Enthalpy Analytical, five different outlets in the facility tested over the allowable ALE 5.5 ppb. This poses a potential health, safety or personal rights risk to persons in care.

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The licensee will provide evidence of outlets testing at under the Action Level 5 ppb.

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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: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022


LIC809 (FAS) - (06/04)
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