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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343607712
Report Date: 01/23/2023
Date Signed: 01/23/2023 12:29:00 PM

Document Has Been Signed on 01/23/2023 12:29 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - NATOMA (PRESCHOOL)FACILITY NUMBER:
343607712
ADMINISTRATOR:SANDHU, PARVEENFACILITY TYPE:
850
ADDRESS:420 NATOMA STATION DR.TELEPHONE:
(916) 353-0687
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 20DATE:
01/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jeanie YangTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst Jennifer Velasco (LPA) met with Facility Representative Jeanie Yang (D1) for an unannounced case management inspection regarding lead testing.

During today's inspection, there was a census of 20 children being supervised by four classroom staff. 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 12/17/2022, the facility had lead testing conducted using water samples from facility outlets. Lead testing identified one water outlet that has an Action Level Exceedance (ALE) over the amount of 5.5 parts per billion (ppb). The water outlet identified as "B" tested with an ALE of 9.19 ppb.

D1 stated water outlet B is no longer in use. LPA observed outlet B to be rendered inaccessible by use of plastic sheeting affixed to the outlet. The plastic sheeting had affixed to it a sign: "OUT OF SERVICE DO NOT USE." D1 stated the classroom is not in use and will not be in use until the outlet has been retested and is no longer in exceedance.

Alternative drinking water has been provided to the children through a drinking fountain in the classroom to which children were removed, and children bring their own water bottles.

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

Deficiency cited on the following page and is considered a a potential threat to the health and safety of children in care if not corrected. LPA reviewed this report with the Facility Representative and conducted an exit interview. Appeal Rights were provided. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
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)
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Document Has Been Signed on 01/23/2023 12:29 PM - It Cannot Be Edited


Created By: Jennifer Velasco On 01/23/2023 at 11:30 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: KINDERCARE LEARNING CENTER - NATOMA (PRESCHOOL)
FACILITY NUMBER: 343607712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) ... "values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by
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Facility Representative (D1) stated usage of the outlets was stopped upon receipt of testing results. Facility will use a different classroom with a water outlet that tested within requirements. ALE outlet will remain inaccessible until repaired or replaced to meet health and safety requirements.
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record review, showing one water outlet tested in exceedance of the allowed 5.5 ppb, which poses a potential health, safety, or personal rights risk to children in care.
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 D1 stated the facility will email to LPA all required documents at
jennifer.velasco@dss.ca.gov

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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Jennifer Velasco
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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