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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317946
Report Date: 10/08/2024
Date Signed: 10/08/2024 12:07:45 PM

Document Has Been Signed on 10/08/2024 12:07 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:EARL WARREN PRESCHOOLFACILITY NUMBER:
340317946
ADMINISTRATOR/
DIRECTOR:		SARABA, SUZANNEFACILITY TYPE:
850
ADDRESS:5420 LOWELL STREETTELEPHONE:
(916) 382-5934
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 22DATE:
10/08/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Suzanne SarabaTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On Tuesday, October 8 2024, Licensing Program Analysts (LPAs) Tanya Washington and Lea Habtom met with Site Supervisor, Suzanne Saraba, to conduct an unannounced case management for a Lead Exceedance Inspection. The purpose of today's inspection was to create a plan of correction following a report of lead exceedance in facility outlet.

On 12/26/2022, the facility tested water sample for lead. One water outlet sample indicated an Action Level Exceedance (ALE). The outlet that tested in exceedance is drinking fountain B located outside with 36 ppb. Site Supervisor indicated that she is not sure if the lead exceedance has been addressed since it was last tested. The facility was notified that water lead levels were in exceedance of 5.5 parts per billion.

A plan of correction is being issued to ensure the outlet is made inoperable, removed, and/or replaced. All other faucets used by preschool children have been tested and are not in Action Level Exceedance. Site Supervisor will connect with the school district to decide to either cap off the tap or to replace and retest the outlet or provide verification that the lead exceedance has been addressed and the drinking fountain has been replaced. LPA printed and provided LIC9275 and LIC9276 for Site Supervisor to complete and submit.

LPA informed Licensee Representative of Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP.

A deficiency is cited on the following LIC809-D page and the plan of correction was reviewed with the Site Supervisor, Suzanne Saraba. An exit interview was conducted with Site Supervisor, Suzanne Saraba.



A copy of this report and appeal rights were provided. A notice of site visit was provided and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 10/08/2024 12:07 PM - It Cannot Be Edited


Created By: Tanya Washington On 10/08/2024 at 11:37 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EARL WARREN PRESCHOOL
FACILITY NUMBER: 340317946

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited

1017003(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A .. values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement has not been met by evidence: Outlet B (drinking fountain outside) has a lead exceedance of 36 ppb. This is considered as a potential
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Facility will provide proof of correction to LPA Washington's e-mail by POC date: 11/08/2024.

tanya.washington@dss.ca.gov
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risk to the children 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:Amanda Blesi
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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