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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624134
Report Date: 06/07/2023
Date Signed: 06/07/2023 09:49:36 AM

Document Has Been Signed on 06/07/2023 09:49 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LRCCD SCC CHILD DEVELOPMENT CENTERFACILITY NUMBER:
343624134
ADMINISTRATOR:SADAT ZAREKFACILITY TYPE:
830
ADDRESS:3835 FREEPORT BLVDTELEPHONE:
(916) 650-2757
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 3DATE:
06/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:TIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:40am and met with Director Sadat Zarek to conduct an unannounced case management inspection. During today's inspection there were three preschool children being supervised by three teachers. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in five of the facility outlets.

On 2/24/2023 the facility tested water samples for lead. Three water outlets sampled indicated an Action Level Exceedance (ALE). On 5/12/2023 the facility was notified that water levels were in exceedance of 5 parts per billion in the locations that were tested.

Signs have been placed on each outlet in exceedance stating that the outlets should not be used for drinking or food preparation. Director stated that the faucets are currently being changed to correct the issue.

A deficiency is cited on the following LIC809-D and the plan of correction was reviewed with the Director, Sadat Zarek. A copy of this report and appeal rights were provided to the Director.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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 06/07/2023 09:49 AM - It Cannot Be Edited


Created By: Christopher Bello On 06/07/2023 at 09:17 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: LRCCD SCC CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 343624134

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3 ...Lead Action Level... (b) ...(1) If testing indicates an Action Level Exceedance at any water outlet, the water... is deemed not safe to drink and an immediate response... shall be required. This requirement was not met as evidenced by:
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Facility has since stopped using the water that was designated exceeding lead levels. The facility has a work order to correct the faucets that will be sent to the LPA.
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Based on record review the facility did not comply with the above regulation as the lead action level was exceeded in three water outlets, which poses 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:Amanda Blesi
LICENSING EVALUATOR NAME:Christopher Bello
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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