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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475403152
Report Date: 10/23/2024
Date Signed: 10/23/2024 11:49:07 AM

Document Has Been Signed on 10/23/2024 11:49 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:FORT JONES ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
475403152
ADMINISTRATOR/
DIRECTOR:		LANG, RAYLENEFACILITY TYPE:
850
ADDRESS:11501 MATHEWS STREETTELEPHONE:
(530) 468-2412
CITY:FORT JONESSTATE: CAZIP CODE:
96032
CAPACITY: 24TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
10/23/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Melanie MendenhallTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 10/23/2024 at 11:15 AM, Licensing Program Analyst (LPA) Noah Wheeler made a case management inspection and met with Site Supervisor Melanie Mendenhall. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water:

Faucet “F” – Children's bathroom sink, 14 ppb

The Site Supervisor has made the faucet inaccessible by turning the faucet off. The Site Supervisor has replaced and will retest the faucet. Children in care are receiving drinking water from their own water bottles.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Site Supervisor Melanie Mendenhall.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Noah Wheeler
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 11:49 AM - It Cannot Be Edited


Created By: Noah Wheeler On 10/23/2024 at 11:32 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: FORT JONES ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 475403152

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

101700.3(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement was not met as evidenced by:

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 The Site Supervisor has made the faucet temporarily inaccessible by shutting the water off to the faucet. The Site Supervisor replaced the faucet and will retest the faucet. Retesting documents will be submitted within 4 weeks of the completed sampling.
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Based on record review, the facility had one faucet with lead test results exceeding 5 ppb of lead in the water. 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:Erin Virrueta
LICENSING EVALUATOR NAME:Noah Wheeler
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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