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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620822
Report Date: 09/15/2022
Date Signed: 09/15/2022 10:59:52 AM

Document Has Been Signed on 09/15/2022 10:59 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:CAPC - MANTECA DAYFACILITY NUMBER:
393620822
ADMINISTRATOR:MEIHL, JADEFACILITY TYPE:
850
ADDRESS:737 WEST YOSEMITE AVENUETELEPHONE:
(209) 644-5311
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 14DATE:
09/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Victoria BrownTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA's) Mariya Melnichuk and Katy Maestas met with Site Supervisor Victoria Brown for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 05/11/2022 which tested the water in the facility. LPA verified that all required adults have a clear background check by accessing guardian.

LPA was notified of the lead testing report which was dated 5/11/2022. The report revealed that one water outlet had elevated levels of lead. LPA observed that the faucet had been marked as "closed" and currently inaccessible for use. Site Supervisor stated that the room was currently not in use and LPA's observed that the classroom was being used for storage. Site Supervisor stated that she is in the flushing process which will be completed on 9/23/2022 and water will be retested. Site Supervisor understands that once the report is received, it must be emailed to the LPA.

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 Site Supervisor. 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: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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 09/15/2022 10:59 AM - It Cannot Be Edited


Created By: Mariya Melnichuk On 09/15/2022 at 10:34 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: CAPC - MANTECA DAY
FACILITY NUMBER: 393620822

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2022
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. This requirement was not met as evidenced by:
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During today's visit LPA observed that the affected water outlets are not in use. SIte Supervisor stated that once she was informed, she took immediate action. Re-testing will take place after flushing. SIte Supervisor will email test results to LPA. Deficiency will be cleared during visit.
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The water report dated 05/11/2022 revealed that the facility had elevated levels of lead in one water faucet. 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:Chayntel Hunter
LICENSING EVALUATOR NAME:Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022


LIC809 (FAS) - (06/04)
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