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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103810104
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:40:02 PM

Document Has Been Signed on 09/26/2023 04:40 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:JACK & JILL'S EARLY CHILD DEVELOPMENT CENTER, INCFACILITY NUMBER:
103810104
ADMINISTRATOR:GRAVES, EARLINE EVETTEFACILITY TYPE:
850
ADDRESS:969 S WILLOW AVETELEPHONE:
(559) 255-8817
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 37DATE:
09/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Earline GravesTIME COMPLETED:
04:45 PM
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On 09/26/2023, Licensing Program Analysts (LPAs) Aurelio Mendoza and Julie Baptista conducted an unannounced case management visit to review facility’s compliance with lead water testing requirements for childcare centers. LPAs explained purpose of inspection and took a census.

Per interview with Director Earline Graves and review of records it has been found that facility is not in compliance with Written Directives outlined in PIN 21-21.1-CCP and Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, that requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Based on interview and record review, the licensee did not comply with the section cited above and has not tested the water at the facility, which poses a potential health, safety, or personal rights risk to persons in care.

During the visit Director Earline Graves reported that bottled drinking water is provided at facility via vendor.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page).



Please see 809-D.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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 09/26/2023 04:40 PM - It Cannot Be Edited


Created By: Aurelio Mendoza On 09/26/2023 at 03:59 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: JACK & JILL'S EARLY CHILD DEVELOPMENT CENTER, INC
FACILITY NUMBER: 103810104

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2023
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:

Based on interview and record review, the licensee did not comply with the section cited above Licensee has not tested the water at the facility, which poses a potential health, safety or personal rights risk to persons in care.
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Licensee agrees to either have the water tested as required by Assembly Bill 2370 or submit a request for a waiver to be considered for exemption to Community Care Licensing Department by POC date 11/26/23. If testing the water in the facility, the written directives require that the facility submit to your LPA copies of the following documents within 2 weeks of the completed sampling date:
   (1) Completed and signed External Water Sampler Self-Certification Form (LIC 9275).
   (2) Facility Sketch (LIC 999) fully labeled with the locations of all water outlets, including outlets that will not be sampled.
   (3) Completed and signed Child Care Center Sampling Checklist Form (LIC 9276).

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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:Cynthia Brannon
LICENSING EVALUATOR NAME:Aurelio Mendoza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
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