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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611566
Report Date: 03/24/2023
Date Signed: 03/24/2023 09:37:25 AM

Document Has Been Signed on 03/24/2023 09:37 AM - 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:WCIC-PLAYMATE CHILD DEVELOPMENT CENTER IIFACILITY NUMBER:
343611566
ADMINISTRATOR:DAVIS EDENAUSEGBOYEFACILITY TYPE:
850
ADDRESS:3555 3RD AVENUETELEPHONE:
(916) 457-8661
CITY:SACRAMENTOSTATE: CAZIP CODE:
95817
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
03/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Leticia Jaramillo, Janet Wong-AcordaTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPAs) met with facility representatives, Site Supervisor Leticia Jaramillo (D1) and Head Teacher Janet Wong-Acorda (S1), to conduct an unannounced case management inspection regarding lead testing. During today's inspection there was a census of 0 preschool children on site; Fridays are a teacher work day in the facility. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in one of the facility outlets. The facility's hours of care are Monday-Thursday, 7:30 AM to 3:00 PM; the facility does not operate during the summer months.

On 1/20/2023, the facility vendor tested water samples for lead. CCL received the results of this testing on 03/15/2023. The Lead Testing identified that a water outlet had a Lead Exceedance over the amount of 5.5 ppb. The water outlet sampled is marked H, which is the faucet that was located on the playground.

D1 stated usage of the faucet was stopped immediately upon receiving the results, and a water jug filled in kitchen is now being used a source for water. The facility removed the outlet and may replace it in the future. D1 stated if they do replace the water outlet on the playground,she will inform LPA prior to use.



Deficiency is cited on the subsequent page of the report and is considered a potential threat to the health and safety of children in care, if not corrected.

An exit interview was conducted with the Director. LPAs provided D1 with Appeal Rights. Lead testing results, and a Notice of Site Visit were provided; both must be posted for 30 days for parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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 03/24/2023 09:37 AM - It Cannot Be Edited


Created By: Jennifer Velasco On 03/24/2023 at 09:10 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: WCIC-PLAYMATE CHILD DEVELOPMENT CENTER II
FACILITY NUMBER: 343611566

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... value 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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Director (D1) stated usage of the outlet was stopped immediately upon receiving the results and the outlet was later removed. Director stated the children are provided water via a large jug and water bottles/cups. POC is met.
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Based on record review, one water outlet on the playground, when tested, exceeded the allowed 5.5 ppb, which /posed a potential 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023


LIC809 (FAS) - (06/04)
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