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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318126
Report Date: 09/05/2023
Date Signed: 09/05/2023 12:45:05 PM

Document Has Been Signed on 09/05/2023 12:45 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:PRAIRIE ELEMENTARYFACILITY NUMBER:
340318126
ADMINISTRATOR:KEVAL, FAWZIAFACILITY TYPE:
850
ADDRESS:5251 VALLEY HI DRIVETELEPHONE:
(916) 399-1050
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 118TOTAL ENROLLED CHILDREN: 118CENSUS: DATE:
09/05/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Laura AndersonTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with principal, Laura Anderson, for a case management inspection because of the water testing done at the facility. Purpose of the inspection was explained.

The facility had the water test conducted on August 02, 2023 for the lead. Based on the report, faucet labeled J had 8.6 PPB, faucet labeled K had 5.4 PPB lead in the water. LPA discussed with principal that the Department's requirements are that the findings must be lower than 5.5 PPB. Principal stated that the facility is not using that faucets for drinking anymore. The facility is using the water dispenser with filter and bottled water for drinking water. During the inspection, LPA observed the faucets being made inaccessible.

Copy of this report was reviewed and provided to the principal. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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