<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810217
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:54:43 AM

Document Has Been Signed on 01/26/2023 10:54 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:LIFEHOUSE CHRISTIAN PRESCHOOLFACILITY NUMBER:
153810217
ADMINISTRATOR:CLEMENT, CINDYFACILITY TYPE:
850
ADDRESS:3311 MANOR STTELEPHONE:
(661) 588-1212
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 33DATE:
01/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cindy ClementTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 26, 2023 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management inspection. LPA McWilliams met with Director Cindy Clement. The purpose of today’s inspection was to conduct a case management inspection and to notify the facility that there has been 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. LPA conducted a tour of the facility inside and out and a census was taken.

Fresno South Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from BSK Associates and discussions with Director Clement it has been determined that there is an exceedance to outlet A in the facility. LPA McWilliams inspected outlet A it was observed to be an sink faucet that was impacted with 9.2 ppb(ALE) of lead. Director Clement, has discontinued the use of sink faucet A for drinking water by; placing a sign stating "Do not use for drinking water" and the water has been temporarily disabled. A water filtration system has been placed under the sink as well.

(See plan of correction for further corrective action 809D). Director Clement has notified authorized representatives of this corrective action English; there are no spanish speaking parents. The results are posted on the parent board.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809D). Director Clement was provided a copy of the appeal rights. An exit interview was conducted with Director Clement.

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: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/26/2023 10:54 AM - It Cannot Be Edited


Created By: Kari McWilliams On 01/26/2023 at 10:30 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: LIFEHOUSE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 153810217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2023
Section Cited

101700.3

1
2
3
4
5
6
7
(a)California’s Action Level for lead in water at Child Care Centers is 5ppb.(b) ... (1) A result with values of 5.5ppb 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, the water from that outlet is deemed not safe to drink an immediate response pursuant
1
2
3
4
5
6
7
LPA observed the faucet is no longer used faucet A for drinking water; parents/guardians have been informed and a water filtration system has been put in place; water from an outside source is being used to provide drinking water to children in care.
8
9
10
11
12
13
14
 to section 101704 shall be required.
This requirement was not met by evidence by:Based on record review provided by BSK Associates a result of (ALE) of 9.2 for outlet A which is out of compliance over the allowable ALE 5.5ppb. This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Oulet A is in the process of being flushed and retested. Director Clement will send in the results of the new test when they are received.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Kari McWilliams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2