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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393603371
Report Date: 02/16/2023
Date Signed: 02/16/2023 10:28:15 AM

Document Has Been Signed on 02/16/2023 10:28 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:NIGHTINGALE SCHOOL PRESCHOOLFACILITY NUMBER:
393603371
ADMINISTRATOR:KATHLEEN HAGANFACILITY TYPE:
850
ADDRESS:1721 CARPENTER ROADTELEPHONE:
(209) 933-7260
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 12DATE:
02/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Kathleen HaganTIME COMPLETED:
11:00 AM
NARRATIVE
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On Thursday,February 16, 2023 at 9:40 AM Licensing Program Analyst (LPA) Carla Polanco met with Lead Teacher, Kathleen Hagan for a Case Management inspection. The purpose of the inspection was to follow up on a recent report of the lead testing in the facility of the water used for drinking and cooking. Present in the facility were 2 staff supervising 12 children.

Licensing Regional Office notified the Stockton Unified School District, Compliance Specialist, Mary Dunway


on Wednesday, February 8, 2023, that a report from the State Water Resources Control Board revealed that facility has a water outlet (sink faucet) with elevated levels of lead.

Compliance Specialist Dunway, reported on February 14, 2023, that facility made all outlets with elevated levels of lead inaccessible to use until all affected outlets can be replaced or repaired. The facility is using drinking water from a fountain from an outlet that is not affected.

During today's inspection LPA verified that the affected water outlets are not in use.

Deficiency cited on subsequent page 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Lead teacher Hagan.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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 02/16/2023 10:28 AM - It Cannot Be Edited


Created By: Carla Polanco Rivera On 02/16/2023 at 10:03 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: NIGHTINGALE SCHOOL PRESCHOOL
FACILITY NUMBER: 393603371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited

101700.3(b)(1)

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Lead Testing (b)(1) A result wich values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by:
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During today's visit LPA observed that the affected water outlet is not in use. Sink is taped off and Marked "NOT IN USE". Facility usesalterante drinking water fountain not affected and a cooler with bottled water when outside. Deficiency will be cleared during today's visit.
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A water report revealed that he facility had elevated levels of lead in one of the sinks. This is a potential health and safety risk to children 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:Jeanne Smith
LICENSING EVALUATOR NAME:Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023


LIC809 (FAS) - (06/04)
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