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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293610491
Report Date: 03/22/2023
Date Signed: 03/22/2023 10:36:09 AM

Document Has Been Signed on 03/22/2023 10:36 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:OUR PLAYHOUSE TOOFACILITY NUMBER:
293610491
ADMINISTRATOR:VIDA LOVELADYFACILITY TYPE:
850
ADDRESS:415 COYOTE STREETTELEPHONE:
(530) 265-3262
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 13DATE:
03/22/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mandy LoveladyTIME COMPLETED:
10:45 AM
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On 03/22/2023, Licensing Program Analyst (LPA) Matthew Gallo met with Licensing Representative Mandy Lovelady for an unannounced Case Management Inspection. Upon arrival, LPA observed 13 children supervised by three staff members.

On 1/18/2023, a water sample taken from a fountain located inside the classroom was collected and tested for the presence of lead. The test results indicated lead values of 14.5 parts per billion (pbb), exceeding the recommended 5.5 pbb. Upon arrival, LPA observed signs above the faucet warning that it is to be used for hand washing only and not for drinking or food prep. Representative explained that they provide an alternative water supply through bottled water, and LPA observed sufficient water bottles in fridge. There are other faucets that available for cooking and washing hands.

Deficiencies are cited on the subsequent page of the report per written directives 101700.3 (b)(1). See LIC 809-D.

An exit interview was conducted with the Licensing Representative. The facility has posted the report indicating the results. LPA provided licensing representative with Appeal Rights, and a Notice of Site Visit that must be posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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 03/22/2023 10:36 AM - It Cannot Be Edited


Created By: Matthew Gallo On 03/22/2023 at 10:22 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: OUR PLAYHOUSE TOO
FACILITY NUMBER: 293610491

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) ... "values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Facility will permanently remove water faucet
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Test results indicated an Action Level Exceedance (ALE) of 14.5 ppb in samples collected from the drinking fountain in the classroom which posed a potential health, safety, or personal rights risk to children in care if not corrected
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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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023


LIC809 (FAS) - (06/04)
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