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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100403323
Report Date: 01/19/2023
Date Signed: 01/19/2023 11:16:14 AM

Document Has Been Signed on 01/19/2023 11:16 AM - 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:FRESNO EOC WILSON HEAD STARTFACILITY NUMBER:
100403323
ADMINISTRATOR:RODRIGUEZ, ANGELITAFACILITY TYPE:
850
ADDRESS:1325 STILLMANTELEPHONE:
(559) 263-1205
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 13DATE:
01/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angelita RodriguezTIME COMPLETED:
11:30 AM
NARRATIVE
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On 1/19/2023, LPA’s Ruby Ocegueda and Denisia Jimenez conducted an unannounced case management inspection. LPAs met with Teacher Director Angelita Rodriguez for the purpose of reviewing 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. A tour of the facility was taken and census information was obtained.

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 the Child Care Center Lead Sampling and Reporting Tool, it was determined that multiple outlets were tested on 10/22/2022. Outlet D which is identified as a bathroom sink faucet was impacted with an ALE of 12 ppb. These results indicate out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). Outlet D has been temporarily made inoperable and is in the planning stages of repair. Licensee agrees to continue with the resampling process for an action level result of under 5.5 ppb for compliance with a Certified Sampler.

Children drink water from paper cups and water is stored and dispensed from a portable igloo. Water is obtained from the kitchen sink (outlet B) which was also tested for lead and did not result in any ALE. Per Teacher Director Rodriguez, the facility has not yet posted results for parents to review per PIN 21-21 CCP WD 101703 (b). In addition, Teacher Director stated that parents and guardians have not yet been notified of the (ALE ) Per PIN 21-21 CCP WD 101704 (b)(3). While at the facility, LPA Ocegueda spoke to Ronnie Cantu who Director Rodriguez identified as the Director of Maintenance. Mr. Cantu stated that faucet/outlet D has been replaced and will be retested on 1/24/2023.

Report continued to 809-C
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: FRESNO EOC WILSON HEAD START
FACILITY NUMBER: 100403323
VISIT DATE: 01/19/2023
NARRATIVE
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LPA’s reviewed the requirements to post results and notify parents of ALE. In addition, LPA Ocegueda reviewed all the documents that are required to be submitted to the Department along with the original lab report and the updated report after retest. The documents/forms to be submitted are the LIC 9275 External Water Sample Self-Certification Form, LIC 9276 Child Care Center Sampling Checklist, the facility sketch with identified outlets that were tested as well as any photos that were taken during testing.
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). Teacher Director Rodriguez 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: Susie Fanning
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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Document Has Been Signed on 01/19/2023 11:16 AM - It Cannot Be Edited


Created By: Ruby Ocegueda On 01/19/2023 at 10:54 AM
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: FRESNO EOC WILSON HEAD START
FACILITY NUMBER: 100403323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited

101700.3

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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.
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Teacher Director Rodriguez stated she would notify parents and guardians of the ALE and will post ALE results at a reasonable location for Authorized Representatives to review. Outlet D has been replaced and is in the process of being retested. Outlet D was verified to be made temporarily inoperable.
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This requirement was not met evidence by: Based on record review and interview, Outlet D showed to have been impacted with an ALE of 12 ppb. This result indicates out of compliance over (ALE) 5.5 ppb, which poses a potential health, safety or personal rights risk to persons in care.
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 Original lab report from sample date 10/22/2022 and new lab report along with LIC 9275, LIC 9276, facility sketch and any supporting photos will be submitted to the Department by POC date 2/16/2023.

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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:Susie Fanning
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


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