<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503601351
Report Date: 05/08/2023
Date Signed: 05/08/2023 03:08:38 PM

Document Has Been Signed on 05/08/2023 03:08 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:HUGHES HEAD STARTFACILITY NUMBER:
503601351
ADMINISTRATOR:VISCOVICH, ANDREYAFACILITY TYPE:
850
ADDRESS:512 NORTH MCCLURE RDTELEPHONE:
(209) 571-2486
CITY:MODESTOSTATE: CAZIP CODE:
95357
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 0DATE:
05/08/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:TIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/08/23 Licensing Program Analysts (LPA) Araceli Gibson and (LPA) Yesenia Fierro conducted an unannounced case management inspection. LPA met with the site supervisor Sheri Lamarre and Coordinator Consuelo Cenento for the purpose of conducting a case management inspection, regarding a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Fresno Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from Child Care Center Lead Sampling and Reporting Tool and self reported information to the licensee # 503601351 two outlets were impacted with an (ALE) of 5.9 ppb outlet C and 8.1 ppb in outlet D. This result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D)The outlet has temporarily been made inoperable and is in the planning stages of repair. Director agrees to continue with the resampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler.

Site Supervisor stated children are provided water from a potable source in the kitchen by use of an pitcher and cups for outdoors and in the classroom there is a drinking bubbler accessible to the children. Potable water is also made available to visitors and staff during hours of operation. Facility has posted results for parents to review Per PIN 21-21-1 CCP WD 101703 (b). In addition, parents and guardians were notified by letter and electronically the (ALE ) Per PIN 21-21-1 CCP WD 101704 (b)(3).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809 D). Site Supervisor was provided a copy of appeal rights. 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: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
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 05/08/2023 03:08 PM - It Cannot Be Edited


Created By: Araceli Gibson On 05/08/2023 at 01:56 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HUGHES HEAD START
FACILITY NUMBER: 503601351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2023
Section Cited

101700.3

1
2
3
4
5
6
7
(a) California’s Action Level for lead in water at Child Care Centers is 5 ppb.(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. Testing results with fractional ppb readings of less than 0.5 ppb shall be rounded down 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. (2) 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. (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.
1
2
3
4
5
6
7
Coordinator agrees to submit evidence of replacement and remediation on outlets C and D for testing at or below Action Level. Coordinator is requesting a waiver for an extention for tesiting due to summer session closure for accurate testing results and will need more time. Waiver to be submitted by POC due date 06/08/23.
8
9
10
11
12
13
14
This requirement was not met evidence by: Based on record review provided by licensee indicating (ALE) of 5.9 ppb in outlet C and 8.1 ppb in outlet D. These results indicate out of compliance over (ALE) 5.5 ppb, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Director has notified parents and guardians and posted (ALE) results at a reasonable location for Authorized Representatives to review.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Araceli Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2023


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