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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500300293
Report Date: 12/05/2022
Date Signed: 12/05/2022 11:14:35 AM


Document Has Been Signed on 12/05/2022 11:14 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:ORANGEBURG CHRISTIAN SCHOOLFACILITY NUMBER:
500300293
ADMINISTRATOR:MCFALL, CHANTELFACILITY TYPE:
850
ADDRESS:313 EAST ORANGEBURG AVETELEPHONE:
(209) 577-2575
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:80CENSUS: 22DATE:
12/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Chantel McFallTIME COMPLETED:
11:30 AM
NARRATIVE
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On December 5, 2022 Licensing Program Analyst (LPA), Kari McWilliams conducted an unannounced case management inspection. LPA met with Director Chantel McFall. LPA McWilliams conducted a tour of the facility and a census was taken. LPA informed Director McFall that the purpose of todays inspection is to conduct a Case Management Inspection regarding a lead exceedance referred to, as an Action Level Exceedance (ALE) of over 5.5 parts per billion (bbp) in the water at this facility.

Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test that was conducted on September 10, 2022. Based on records reviewed from Forensic Analytical Consulting Services and discussions with Director McFall it has been determined there is an exceedance to outlet Fixture C in the facility. LPA McWilliams inspected fixture C, and it was observed to be an outdoor water fountain that was impacted with a test result of 6.3 ppb (ALE) of lead. LPA McWilliams observed that the fountain has been removed and the water pipes have been capped. (See Plan of Corrections for further corrective actions on LIC809-D). Director McFall has notified authorized representatives of this correction.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, a Type B deficiency is being cited: (see next page, LIC 809-D). Director McFall was provided a copy of appeals rights. An exit interview was conducted with Director McFall

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 12/05/2022 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: ORANGEBURG CHRISTIAN SCHOOL
FACILITY NUMBER: 500300293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2022
Section Cited

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(a) California's Action Leve for lead in water at Child Care Centers is 5 ppb. (1) A result with values of 5.5 ppb or greater shall bedeemed an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
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This requirement was not met evidenced by: Based on record review provided by [Name of ELAP Certified Laboratory] Analytical a result of (ALE) of 6.3 ppb for fixture c. Which is out of compliance over the allowable ALE 5 ppb. This poses a potential health, safety or personal rights risk to persons 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: Susie FanningTELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Kari McWilliamsTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
LIC809 (FAS) - (06/04)
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