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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393612087
Report Date: 10/23/2024
Date Signed: 10/23/2024 10:39:27 AM

Document Has Been Signed on 10/23/2024 10:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TENDER LOVING CAREFACILITY NUMBER:
393612087
ADMINISTRATOR/
DIRECTOR:		CHARLA B. & KRISTINA L.FACILITY TYPE:
850
ADDRESS:1219 WHISPERING WIND DRIVETELEPHONE:
(209) 832-2990
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: DATE:
10/23/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Charla BandyTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Corina Beckby met with Site Director, Charla Bandy for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 09/21/2024 which tested the water in the facility.

The report revealed that one water fountain had elevated levels of lead. LPA was provided a facility sketch to identify specific water fountain in room 7. Site Director stated the water fountain and the pipe was removed from the water source. LPA observed the missing fountain and pipe. Fountain water from a different water source is offered and parents bring bottled water. LPA explained the water outlet must be re-tested before use of the outlet is resumed. Site Director 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. The deficiency was cleared at the time of visit. An exit interview was conducted, and the report was reviewed with Site Director, Charla Bandy. 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: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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 10/23/2024 10:39 AM - It Cannot Be Edited


Created By: Corina Beckby On 10/23/2024 at 10:30 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: TENDER LOVING CARE
FACILITY NUMBER: 393612087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2024
Section Cited

101700.3(b)(1)

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Lead Testing (b)(1) A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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During today's visit, LPA observed that the affected drinking water outlet is not in use. Site Director 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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This requirement was not met as evidenced by:
The water report dated 09/21/2024 revealed that the facility had elevated levels of lead in a water fountain in room 7. 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: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
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