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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313625035
Report Date: 02/06/2024
Date Signed: 02/06/2024 03:55:47 PM

Document Has Been Signed on 02/06/2024 03:55 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STAR RIDGEVIEWFACILITY NUMBER:
313625035
ADMINISTRATOR:KELLY, ALLISONFACILITY TYPE:
840
ADDRESS:9177 TWIN SCHOOLS ROADTELEPHONE:
(916) 632-8407
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 17DATE:
02/06/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Allison KellyTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jeremey McClain met with Licensing Representative Allison Kelly for an unannounced Case Management Inspection. Upon arrival, LPAs observed 17 children supervised by four staff members.

On 12/06/2023, a sample from a faucet/fountain combo located in the classroom was collected and tested for lead exceedance. Results indicated lead values 9.3 parts per billion (pbb), exceeding the recommended 5.5 pbb. The source was previously used for drinking and washing hands.

Usage of the water source was stopped immediately upon receiving the results, and the fountain and faucet has been made inaccessible. Water bottles are currently being provided for drinking in lieu of the fountain. Children wash their hands in the bathroom when necessary.
Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected.

An exit interview was conducted with the licensing Representative. LPA informed licensing representative that the results must be posted. 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: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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 02/06/2024 03:55 PM - It Cannot Be Edited


Created By: Jeremey McClain On 02/06/2024 at 03:12 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: STAR RIDGEVIEW
FACILITY NUMBER: 313625035

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers. 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.
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During the inspection, LPA observed that the faucet has been blocked off an not being used. Facility is utilizing water bottles for drinking and the bathroom for handwashing.
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This requirement was not met as evidenced by testing results from 12/07/2023 indicating a level of 9.3 ppb. This is a potential risk to the health and safety of 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:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2024


LIC809 (FAS) - (06/04)
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