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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624951
Report Date: 12/15/2023
Date Signed: 12/15/2023 11:34:18 AM

Document Has Been Signed on 12/15/2023 11:34 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:L'ACADEMY LANGUAGE IMMERSION PRESCHOOL FOLSOMFACILITY NUMBER:
343624951
ADMINISTRATOR:ROYAL, ANNAFACILITY TYPE:
830
ADDRESS:1815 PRAIRIE CITY ROADTELEPHONE:
(408) 916-7536
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 1DATE:
12/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Anna RoyalTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Manager (LPM) Natalie Dunaway and Licensing Program Analysts (LPAs) Stephanie Piring and Jennifer Velasco met with Facility Representative, Director Anna Royal (Director) to conduct an unannounced case management inspection regarding lead testing. The purpose of today's inspection was to document a plan of correction following reports of lead exceedance in two of the facility outlets.

On 11/01/2023, the facility tested water samples for lead. Lead testing identified one water outlet that has a Lead Exceedance over the amount of 5.5 parts per billion (ppb). The water outlet designated as outlet B has an exceedance of 25 ppb.

Director stated water outlet B is in a storage room with Infant Room One and it was already not in use. Director stated the facility put a lock on the door of the storage room in which water outlet B is located immediately upon receiving the results, and the other two outlets in Infant Room One, bottled water, and filtering Brita pitchers are being used as sources for water. Director stated the facility will retest before using water outlet B and will follow up with LPA prior to use.

A 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. An exit interview was conducted with the Director. LPA provided Director with Appeal Rights and a Notice of Site Visit that must be posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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 12/15/2023 11:34 AM - It Cannot Be Edited


Created By: Jennifer Velasco On 12/15/2023 at 11:05 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: L'ACADEMY LANGUAGE IMMERSION PRESCHOOL FOLSOM
FACILITY NUMBER: 343624951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited
HSC
101700.3(b)(1)

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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.
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Director stated the outlet was nover in use and has been rendered inaccessible by use of a lock on the door of the storage room in which it is located, and signage has been posted inside the storage room to ensure no one uses that outlet. Staff have been told not to use the outlet at all, and staff are
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This requirement was not met as evidenced by: Based on record review, one tested water outlet (B) exceeded the allowed 5.5 ppb, which poses a potential health, safety, or personal rights risk to persons in care.
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discussing this citation and the correction with parents.

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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: 12/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023


LIC809 (FAS) - (06/04)
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