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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801072
Report Date: 11/18/2022
Date Signed: 11/18/2022 01:28:21 PM

Document Has Been Signed on 11/18/2022 01:28 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 SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MAPLE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
543801072
ADMINISTRATOR:JONES, LORETTAFACILITY TYPE:
850
ADDRESS:501 W. MAPLE STREETTELEPHONE:
(559) 688-7086
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 99TOTAL ENROLLED CHILDREN: 99CENSUS: 34DATE:
11/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Loretta JonesTIME COMPLETED:
01:45 PM
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On 11/18/2022 Licensing Program Analyst (LPA) Nancy Her conducted an unannounced case management inspection. LPA met with Director, Loretta Jones, The purpose of today's inspection is to notify director 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.

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 Delavalle Laboratories and discussions with Director, LPA inspected outlet (Z) in the preschool classroom 1 that was impacted with 14 ppb (ALE) of lead. Director has disconnected water outlet (Z) until repairs can be made. An IGLOO with water from a portable source and cups are available to preschool children during day care hours. Director has agreed to repair and retest the impacted outlet. Director agrees to submit evidence of the outlet testing under 5.5 ppb action level. Director has agreed to notify authorized representatives of this corrective action.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

Exit interview conducted and report was reviewed with the facility representative Loretta Jones..

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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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Document Has Been Signed on 11/18/2022 01:28 PM - It Cannot Be Edited


Created By: Nancy Her On 11/18/2022 at 12:55 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: MAPLE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 543801072

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited

101700.3

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101700.3 California Lead Action Level at Child Care Centers (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. (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.
This requirement is not met as evidenced by:
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Authorized representatives have been notified. Licensee agrees to repair the drinking fountain and have the outlet resampled by a certified sampler. Licensee will provide evidence of outlet testing at or below action level.
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Based on record review, the licensee did not comply with the section cited above. The report provided by Dellavalle Laboratories resulted in action level exceedance of 14 for outlet Z. 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:Duane Matsubara
LICENSING EVALUATOR NAME:Nancy Her
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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