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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500242
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:38:32 PM

Document Has Been Signed on 02/15/2023 02:38 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:HOOVER ELEMENTARYFACILITY NUMBER:
394500242
ADMINISTRATOR:MAYTE PICHARDOFACILITY TYPE:
850
ADDRESS:2900 KIRK STREETTELEPHONE:
(209) 933-7215
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Teacher, Jennifer Cohen TIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) David Nguyen and Lauren Scott met with teacher, Jennifer Cohen for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report, which tested the water in the facility for lead levels.

LPA was notified of the lead testing report on 02/08/2023 via email. The report revealed that one water outlet had elevated levels of lead. During today's inspection, LPA's observed that the fountain has been covered with paper sign and marked "water not good for drinking." LPA's observed a water jug, cups and bottled water available for children's consumption.

As a result of the water testing positive for lead, a deficiency was cited on a subsequent page, LIC 809D. An exit interview was conducted and the report was reviewed with the teacher, Jennifer Cohen. A Notice of Site 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: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 02:38 PM - It Cannot Be Edited


Created By: David Nguyen On 02/15/2023 at 02:23 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HOOVER ELEMENTARY
FACILITY NUMBER: 394500242

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2023
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 LPAs observed that the affected water outlet is not in use and taped off with a sign stating, "water not good for drinking." Facility is providing water in a water jug with cups and water bottles available to children for consumption.
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The water report revealed that the facility had elevated levels of lead in one water fountain. 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:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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