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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810043
Report Date: 03/02/2023
Date Signed: 03/28/2023 07:25:30 PM

Document Has Been Signed on 03/28/2023 07:25 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:VUSD-CRESTWOOD ELEMENTARY SCHOOL E.L.C.FACILITY NUMBER:
543810043
ADMINISTRATOR:MCLAIN, MARGARETFACILITY TYPE:
850
ADDRESS:3001 W WHITENDALETELEPHONE:
(559) 730-7564
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 55DATE:
03/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Margaret McLainTIME COMPLETED:
11:30 AM
NARRATIVE
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On 3/2/2023, Licensing Program Analyst (LPA) Theresa Marquez conducted an unannounced Case Management inspection and met with Early Childhood Education Lead Margaret McLain. The purpose of today's inspection is to address the 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 South Regional Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test conducted on 11/21/2022. Based on records reviewed from Child Care Center Lead Sampling and Reporting Tool and self reported information from BSK Associates of Laboratory Fresno three outlets are impacted with an (ALE). Outlets identified as follows: Outlet A classroom sink (R) bubbler in room 69 with an (ALE) of 11 ppb, Outlet D classroom sink (R) bubbler in room 74 with (ALE) of 6.2 ppb, and Outlet L outdoor drinking fountain with an (ALE) of 25 ppb.

These results indicates out of compliance of over (ALE) 5.5 ppb. (See Plan of correction for further corrective action LIC 809-D). Outlets A and D have been made temporarily inoperable and have been replaced and are in the flushing stage. Outlet L has been permanently removed. Education Lead McLain agrees to continue with the re-sampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler.

Education Lead McLain stated bottled drinking water is being provided for children and children are also bringing their own bottled water from home. Written notices in English and Spanish of (ALE) was provided to all parents. Written notices of (ALE) are also posted on the outside and inside parent boards 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, LIC 809-D). An exit interview was conducted with Margaret McLain. A Notice of Site Visit (LIC 9213) and copy of Appeal Rights was provided. The LIC 9213 Notice of Site Visit is required to be posted for 30 days. This report shall be made available to the public upon request.
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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 03/28/2023 07:25 PM - It Cannot Be Edited


Created By: Theresa Marquez On 02/24/2023 at 01:18 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: VUSD-CRESTWOOD ELEMENTARY SCHOOL E.L.C.
FACILITY NUMBER: 543810043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2023
Section Cited

101700.3

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(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 (AL). 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 AL. (1) A result with values of 5.5 ppb or greater shall be deemed an ALE. (2) Licensees shall maintain a lead value at or below the AL 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 ALE 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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Education Lead McLain stated replacement has been completed and the flushing stage has began for outlets A & D. McLain will submit evidence of remediation on outlets (A, D,) in classroom 69 and 74 for testing at or below Action Level by POC due date 4/3/2023. Outlet L has been permanently removed. McLain has notified parents and guardians of the ALE. and ALE results are posted at a reasonable location for Authorized Representatives to view. McLain will notify LPA of retesting results by 4/3/2023.
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This requirement was not met as evidenced by: Record review provided by the Child Care Center Lead Sampling and Reporting Tool and the Education Lead McLain's interview indicating (ALE) impacting 3 outlets identified as (A, D, L). These results are out of compliance of over (ALE) 5.5 ppb, which 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:Theresa Marquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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