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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621912
Report Date: 09/14/2022
Date Signed: 09/14/2022 12:51:27 PM

Document Has Been Signed on 09/14/2022 12:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MOORE LEARNING PRESCHOOL & DCC (PS)FACILITY NUMBER:
343621912
ADMINISTRATOR:MOORE, FRISHAFACILITY TYPE:
850
ADDRESS:8699 ELK GROVE BLVDTELEPHONE:
(916) 405-0448
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 71TOTAL ENROLLED CHILDREN: 71CENSUS: 12DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Frisha MooreTIME COMPLETED:
01:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Salene Mayberry met with Director Frisha Moore for an unannounced Case Management Inspection. LPA observed 12 children being cared for by two staff members.

The purpose of today’s inspection was to follow up regarding a water sampling that indicated an Action Level Exceedance (ALE) for a drinking fountain in Room 4 that was tested for lead levels on 06/22/2022. On 07/08/2022 the facility was notified that water levels were in exceedance of 5 parts per billion in the drinking fountain that was tested. Since receiving the notification the water line to this water fountain has been turned off and a notice was posted indicating the outlet is not allowed for use. Alternative drinking water has been provided through the use of bottled water and access to other outlets within the facility.

Director indicated she would be replacing the drinking fountain. LPA informed Director that Grant funding for testing and remediation is available and information can be found in Provider Information Notice (PIN) 21-04-CCP.

A Type B deficiency was cited on the subsequent page (LIC809-D) of this report.

An Exit interview conducted, and the report was reviewed and provided to Director. LPA posted the Notice of Site Visit and Director acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/14/2022 12:51 PM - It Cannot Be Edited


Created By: Salene Mayberry On 09/14/2022 at 12:23 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MOORE LEARNING PRESCHOOL & DCC (PS)
FACILITY NUMBER: 343621912

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited

101700.3(c)

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101700.3 California Lead Action Level at Child Care Centers (c) If testing indicates an...Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response...shall be required. This requirement was not as evidenced by:
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The facility has turned off the water line to the outlet with the exceedances and placed a notice indicating it is not allowed for use. The facility plans to replace the drinking fountain and have it retested. Proof of a new drinking fountain or a test indicating levels of 5 ppb or less will be
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Lead test results received by Licensing on 09/9/2022, tested on 06/22/2022, showed an outlet in the facility had lead levels exceeding 5 parts per billion (ppb). This poses a potential risk to the health and safety of children in care.
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sent to LPA by 10/14/2022.

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Salene Mayberry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022


LIC809 (FAS) - (06/04)
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