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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808581
Report Date: 01/17/2023
Date Signed: 01/17/2023 01:14:40 PM

Document Has Been Signed on 01/17/2023 01:14 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:SYLVAN HEAD STARTFACILITY NUMBER:
503808581
ADMINISTRATOR:HOTCHKISS, JEWELEEFACILITY TYPE:
850
ADDRESS:2908 COFFEE ROADTELEPHONE:
(209) 238-6302
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 33DATE:
01/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Rachel HaslemTIME COMPLETED:
01:30 PM
NARRATIVE
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On January 17, 2023 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management inspection. LPA McWilliams met with Lead Teacher Rachel Haslem. The purpose of today’s inspection was to conduct a case management inspection and to notify the facility that there has been 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. LPA conducted a tour of the facility inside and out and a census was taken.

Fresno North Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from FACS and discussions with Lead Teacher Haslem it has been determined that there is an exceedance to outlet F in the facility. LPA McWilliams inspected outlet F it was observed to be an outside water fountain that was impacted with amount of lead 8.8ppb(ALE) of lead. Lead Teacher Haslem, has discontinued the use of F by; the water to the faucet has been turned off and the faucet is in the process of being replaced. Once it is replaced the outlet will be flushed and retested prior to use.

(See plan of correction for further corrective action 809D). Lead Teacher Haslem has notified authorized representatives of this corrective action in both languages; English and Spanish to all parents through the Learning Genie.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, A type B deficiency is being cited: (see next page, 809D). Head Teacher Haslem were provided a copy of the appeal rights. An exit interview was conducted with Lead Teacher Haslem.

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: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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 01/17/2023 01:14 PM - It Cannot Be Edited


Created By: Kari McWilliams On 01/17/2023 at 12:52 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: SYLVAN HEAD START
FACILITY NUMBER: 503808581

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2023
Section Cited

101700.3

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(a)California’s Action Level for lead in water at Child Care Centers is 5ppb.(b) Testing results with fractional ppb readings of 0.5ppb or greater shall be rounded up..., before comparing to the Action Level. (1) A result with values of 5.5ppb...Action Level Exceedance. (c) If testing indicates an Action Level
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Head Teacher confirmed that the parents/guardians have been notified of the exceedance. LPA observed that the outlet has been made inoperable by turning the water off. A new faucet has been purchased and is in the proccess of being replaced and flushed. Head teacher confirms the results will be sent in when completed.
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Exceedance at any water outlet...This requirement was not met by evidence by: Based on record review provided by FACS a result of (ALE) of 8.8 for outlet F which is out of compliance over the allowable ALE 5.5ppb. 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:Luisa Gavoutian
LICENSING EVALUATOR NAME:Kari McWilliams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023


LIC809 (FAS) - (06/04)
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