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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306383
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:42:01 PM

Document Has Been Signed on 09/19/2024 03:42 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:MARVIN MARSHALL CHILDREN'S CENTERFACILITY NUMBER:
340306383
ADMINISTRATOR/
DIRECTOR:		VONG,JACK,MANI, REYNOLDSFACILITY TYPE:
850
ADDRESS:5309 KENNETH AVENUETELEPHONE:
(916) 971-7380
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 209TOTAL ENROLLED CHILDREN: 209CENSUS: 17DATE:
09/19/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Isabelle McDanielTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On September 19, 2024, at approximately 2:05 PM Licensing Program Analyst (LPA) Josiah Gathing met with Preschool Administrator Isabelle McDaniel to conduct an unannounced case management inspection. During today's inspection there were 17 preschool children present. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in one of the facility outlets.

On April 17, 2024, the facility tested water samples for lead. One water outlet sampled indicated an Action Level Exceedance (ALE). This outlet is marked E on the facility sketch provided by the center. On May 15, 2024 the Licensing Program was notified that water levels were in exceedance of 5 parts per billion in the tested location.

Piping has already been replaced in the outlet testing in exceedence and re-testing has been completed. Staff provided re-testing paperwork during today's inspection.

A deficiency is cited on the following LIC809-D and was cleared upon inspection. A copy of this report and appeal rights were provided to Preschool Administrator.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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 09/19/2024 03:42 PM - It Cannot Be Edited


Created By: Josiah Gathing On 09/19/2024 at 03:10 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: MARVIN MARSHALL CHILDREN'S CENTER
FACILITY NUMBER: 340306383

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
HSC
101700.3(b)(1)

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101700.3 ...Lead Action Level... (b) ...(1) If testing indicates an Action Level Exceedance at any water outlet, the water... is deemed not safe to drink and an immediate response... shall be required. This requirement was not met as evidenced by:
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Prior to today's inspection, piping was already replaced in the faucet testing in exceedence and re-testing was completed 8/20/2024. Citation was cleared upon inspection.
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Based on record review the facility did not comply with the above regulation as the lead action level was exceeded in one water outlet, which poses 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Josiah Gathing
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


LIC809 (FAS) - (06/04)
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