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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808412
Report Date: 01/12/2023
Date Signed: 01/18/2023 08:31:03 AM

Document Has Been Signed on 01/18/2023 08:31 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BCSD/ROOSEVELT ELEMENTARY PRE-KINDERGARTENFACILITY NUMBER:
153808412
ADMINISTRATOR:RIOS, SUSANAFACILITY TYPE:
850
ADDRESS:2324 VERDE STREETTELEPHONE:
(661) 631-4936
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
01/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Storiann CampsTIME COMPLETED:
11:45 AM
NARRATIVE
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On 1/12/23, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility. LPA met with State Preschool Program Coordinator (PC), Storiann Camps to discuss the results of the lead testing of the water at the facility.

Based on information obtained from the water lead sampling test conducted by YES Environmental, Inc., it was determined there was an Action Level Exceedance (ALE), meaning there was a result with values of 5.5 ppb or greater. The ALE of 6.22 ppb was discovered in water source (B) and the ALE of 11.0 ppb was discovered in water source (D). Both water sources are located outside of the Pre-K classroom (#34) and were made inoperable upon the results of the lead exceedance. PC stated a correction action has already begun with the replacement of water source (B) and (D) and both water sources have been covered in plastic with an "out of service" sign placed on them. PC also stated the required flushing of the new water sources has already begun. PC said the water sources will not be used until the results of a second water lead sampling test have been received. PC stated preschool children have individual water bottles that are filled daily at the facility with purchased bottled water and are taken outside with them during outdoor activity.

Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, 101700.3 (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 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:
The following deficiency was cited: (see next page titled 809-D)

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Storiann Camps.

SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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 01/18/2023 08:31 AM - It Cannot Be Edited


Created By: Kathy Pacheco On 01/12/2023 at 10:23 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: BCSD/ROOSEVELT ELEMENTARY PRE-KINDERGARTEN
FACILITY NUMBER: 153808412

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2023
Section Cited

101700.3(c)

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(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. This requirement was not met as evidenced by results from the water lead sampling test showing an ALE
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PC stated the facility will notify parents and/or authorized representatives of the lead exceedances and the corrective action that has already taken placed. PC also said a second water lead sampling test will be conducted, per Written Directives Section 101705 and all required documentation will be submitted
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of 6.22 ppb in water source (B) and 11.0 in water source (D). This poses a potential risk to the health, safey, and/or personal rights of children in care.

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to Community Care Licensing by 2/17/23.

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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:Luisa Gavoutian
LICENSING EVALUATOR NAME:Kathy Pacheco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023


LIC809 (FAS) - (06/04)
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