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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808615
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:24:10 PM

Document Has Been Signed on 02/23/2023 01:24 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:TIERRA SERENA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808615
ADMINISTRATOR:LORENA PALOMOFACILITY TYPE:
850
ADDRESS:17213 CENTRAL VALLEY HWYTELEPHONE:
(661) 746-0671
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 29DATE:
02/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Lorena Palomo- Director TIME COMPLETED:
01:35 PM
NARRATIVE
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On 2/23/23 Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Case Management Inspection. LPA met with Director Lorena Palomo, for the purpose of addressing a lead exceedance, referred to as an Action Level Exceedance (ALE), of over 5.5 parts per billion (ppb) in a water outlet at the facility.

The Fresno Regional Office received notification of a lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from the Child Care Center Lead Sampling Tool, one outlet at the facility, outlet E, is impacted with an (ALE) of 15 ppb , and a second outlet, outlet F, is impacted with an (ALE) of 51 ppb. Both outlets are located in the facility's kitchen. This result indicates out of compliance over (ALE) 5.5 ppb (see plan of correction for further corrective action 809D). Both outlets have been made inaccessible and the licensee is in the planning stages of repair and/or remediation. Director agrees to continue with the re-sampling process for action level results of under 5.5 ppb for compliance with a Certified Sampler. Facility staff are utilizing compliant outlets in the facility's kitchen for dish washing and food preparation purposes.

Facility will post results for parents to review per PIN 21-21-1 CCP WD 101703 (b). In addition parents and guardians have been notified by letter as 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, LIC809 D).

Director 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: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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 02/23/2023 01:24 PM - It Cannot Be Edited


Created By: Jessika Thompson On 02/23/2023 at 12:31 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: TIERRA SERENA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153808615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited

101700.3(b)(1)

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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. 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.
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Director agrees to submit evidence of replacement, removal, and/or remediation of outlet E, and outlet F, located in the facility's kitchen, to the Fresno Community Care Licensing Office by 03/23/23. Director stated that letter were provided to parents on 2/23/22, notification them of testing results. Director stated that she will also post (ALE) results in a reasonable location as soon as possible.
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Based on record review, two outlets at the facility contained a lead exceedance greater than 5.5 ppb. 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:Susie Fanning
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023


LIC809 (FAS) - (06/04)
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