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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623785
Report Date: 01/23/2023
Date Signed: 01/23/2023 10:22:41 AM

Document Has Been Signed on 01/23/2023 10:22 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LILY PAD EARLY LEARNING CENTERFACILITY NUMBER:
313623785
ADMINISTRATOR:THATCHER, STACIFACILITY TYPE:
850
ADDRESS:3330 CHISOM TRAILTELEPHONE:
(530) 863-9443
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
01/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Staci Thatcher, DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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On January 23, 2023, at approximately 8:30 AM Licensing Program Analyst (LPA) Amanda Blesi met with Director Staci Thatcher to conduct an unannounced case management inspection to address a lead exceedance received by the Department. Upon arrival, LPA observed 17 preschool children in care supervised by 2 staff. The purpose of today's inspection is to create a plan of correction following reports of lead exceedance in outlets tested in the facility.

Assembly Bill (AB) 2370, Chapter 676, Statues of 2018, requires all Child Care Center (CCC) licensee with facilities built before January 1, 2010, to test their water outlets used for drinking and food preparation. On 12/21/2022, the facility tested water samples for lead. Results received by the Licensing office showed an exceedance measuring 8.5 ppb. The facility director states they have not received their own results from the lab, therefore, they do not know which outlets are in exceedance, if any. Owner, Michele Zemlicka, states the lab had to test twice due to faulty testing procedures when they first came out and she's not sure the results are even correct. Director states children bring their own lunch and bring their own Sippy Cups for drinking water. When needed, facility uses bottled water to refill the Sippy Cups and LPA observed a package of bottled water in the kitchen. LPA advised until the sinks testing for the exceedance can be identified and remediated, staff will need to continue supply bottled water for refilling the Sippy cups and any food preparation. In addition, all sinks shall be labeled to clearly state they shall not be used for consumption and shall be used for hand washing only.

A deficiency is cited on the following LIC809-D and a plan of correction was created with the Director, Staci Thatcher. Appeal Rights Provided and Notice of Site Visit was given.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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 01/23/2023 10:22 AM - It Cannot Be Edited


Created By: Amanda Blesi On 01/23/2023 at 09:21 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: LILY PAD EARLY LEARNING CENTER
FACILITY NUMBER: 313623785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2023
Section Cited

101700.3(b)(1)

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(b)(1) A result with calues of 5.5 ppb or greater shall be deemed an Action Level Exceedance

This requirement was not met, based on facility test results sent to CCL showing a 8.5 ppb exceedance.
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Director states they never received their results from the Vendor and do not know which outlets have an exceedance, if any. LPA advised to contact their vendor and work with them to identify and repair the affected outlets. To correct the deficiency, director shall supply bottled water for refilling Sippy cups and shall label sinks "do not use for consumption or food preparation". LPA will follow up with director/owner to obtain test results, LIC 9275, LIC9276, LIC 999 facility sketch identifying affected faucets and verify affected outlets have been repaired or replaced.

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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:Amanda Blesi
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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