503600519-8-23-2022-04-CC-AGIN-CHKRNM-20220823131033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503600519
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:10:38 PM

Document Has Been Signed on 08/23/2022 01:10 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	PEARSON ELEMENTARY		FACILITY NUMBER:	503600519
ADMINISTRATOR:	NUNES, HEIDI		FACILITY TYPE:	850
ADDRESS:	500 LOCUST		TELEPHONE:	(209) 574-8192
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 3	DATE:	08/23/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kimbra Draper		TIME COMPLETED:	01:25 PM

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On 08/23/22 Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management inspection. LPA met with Kimbra Draper ECE Coordinator. Purpose of today's inspection is to conduct a case management inspection regarding a water lead exceedance referred to as Action Level Exceedance (ALE) of over 5 parts per billion (ppb) in the drinking water at the Pearson Elementary Preschool facility.

Fresno Regional Office received notification on 05/23/22 of Action Level Exceedance (ALE) at the facility resulting from a recent water lead sampling test. Based on findings from Forensic Analytical Consulting Services reported outlet A in classroom 3A was impacted as it is used for consumption. On May 19, 2022 authorized representatives were notified of the Action Level Exceedance at the facility.

On 08/22/22 LPA Gibson received notification of repair and evidence of a final Water Sampling Report from Forensic Analytical Consulting Services with outlet A testing result under 5 parts per billion (ppb). All outlets are potable for drinking or food preparation. No potential risk for children in care.

Per Directives in PIN21-21 CP 101700.3 California Action Level at Child Care Centers. (b)Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (c) If testing indicates 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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, No deficiency is being cited. An exit interview was conducted.

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.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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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