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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607979
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:21:05 PM

Document Has Been Signed on 10/13/2023 02:21 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TENDER LOVING CAREFACILITY NUMBER:
393607979
ADMINISTRATOR:HEATHER M. & PATRICIA V.FACILITY TYPE:
850
ADDRESS:1001 CAMBRIDGE PLACETELEPHONE:
(209) 836-8948
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 3DATE:
10/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:NIcole Lawson-Pre-K TeacherTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Corina Beckby met with Pre-K Teacher, Nicole Lawson for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 08/22/2023 which tested the water in the facility.

LPA was notified of the lead testing report which was dated 08/22/2023 via email. The report revealed that one drinking water outlet had elevated levels of lead. LPA was provided a facility sketch to identify specific water outlet in the classroom. Pre-K Teacher stated the water faucet has not been used since the pandemic. LPA observed that the water outlet has been marked as "out of service" and covered with a bag, making it inaccessible for use. Bottled water is served to children. LPA explained the water outlet must be re-tested before use of the outlet is resumed. Pre-K Teacher understands that the water report from the water re-test must be submitted to the Regional Office to remain in compliance.

As a result of the water testing positive for lead, a deficiency was cited on a subsequent page, 809D. An exit interview was conducted and the report was reviewed with Pre-K Teacher, Nicole Lawson. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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 10/13/2023 02:21 PM - It Cannot Be Edited


Created By: Corina Beckby On 10/13/2023 at 02:08 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TENDER LOVING CARE
FACILITY NUMBER: 393607979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited

101700.3(b)(1)

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WD 101700.3(b)(1) Lead Testing (b)(1) A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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During today's visit, LPA observed the affected drinking water outlet is not in use. Bottled water is available. Pre-K Teacher will schedule re-testing and submit the water report to the RO to resume using the water outlet. Deficiency was cleared during today's visit.
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The water report dated 08/22/2023 revealed that the facility had elevated levels of lead in 1 drinking outlet. This is a potential health and safety risk to the 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:Bettina Engelman
LICENSING EVALUATOR NAME:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023


LIC809 (FAS) - (06/04)
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