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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403488
Report Date: 02/16/2023
Date Signed: 02/16/2023 12:48:00 PM

Document Has Been Signed on 02/16/2023 12:48 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCED MONTESSORI SCHOOLFACILITY NUMBER:
240403488
ADMINISTRATOR:MACDONALD ANNFACILITY TYPE:
850
ADDRESS:424 W 21ST STREETTELEPHONE:
(209) 722-9823
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 26DATE:
02/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ann MacDonaldTIME COMPLETED:
01:00 PM
NARRATIVE
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On 2/16/23, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced 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. LPA met with Ann MacDonald, Licensee and a census was taken.

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 Environmental Laboratory Accreditation Program (ELAP) report and self-reported information for Merced Montessori School #240403488, impacted with (ALE of 11 ppb in Outlet A Bathroom Fountain). The result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). The outlet has been removed and capped off to make inoperable.

Licensee is providing water to the preschool children by means of individual water bottles. Fresh potable water is also available to preschool children, visitors and staff during hours of operation by means of a water faucet that has been tested and in compliance. The faucet also has an attached filtration system. Parents/authorized representatives have been notified of the (ALE ) Per PIN 20-20 CCP WD 101704 (b)(3). Facility also posted results by email for parents to review Per PIN 20-20 CCP WD 101703 (b).

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). Site Supervisor 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: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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 02/16/2023 12:48 PM - It Cannot Be Edited


Created By: Priscilla Zamudio On 02/16/2023 at 12:24 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: MERCED MONTESSORI SCHOOL
FACILITY NUMBER: 240403488

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited

101700.3

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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. This requirement was not met as evidenced by:
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Licensee has notified and posted ALE results at a reasonable location for Authorized representatives to review. LPA observed that Licensee removed and capped off the outlet for (ALE of 11 ppb in Outlet A Bathroom) and is providing an alternative water source for children. Deficiency cleared
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Based on record review provided by Licensee indicating (ALE of 11 ppb in Outlet A Bathroom Fountain). These results indicate over (ALE) 5.5 ppb, which is out of compliance. This poses a potential health, safety or personal rights risk to persons in care.
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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:Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023


LIC809 (FAS) - (06/04)
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