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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808780
Report Date: 11/03/2022
Date Signed: 11/03/2022 12:05:15 PM

Document Has Been Signed on 11/03/2022 12:05 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:CALIFORNIA IVY LEAGUE PREP ACADEMY, PS & ICFACILITY NUMBER:
153808780
ADMINISTRATOR:MILLER, AMYFACILITY TYPE:
850
ADDRESS:2301 ASHE ROADTELEPHONE:
(661) 832-8300
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 178TOTAL ENROLLED CHILDREN: 178CENSUS: 78DATE:
11/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director, Amy MilerTIME COMPLETED:
12:15 PM
NARRATIVE
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On 11/03/2022, Licensing Program Analyst (LPA), Jose Penate conducted an unannounced case management inspection. LPA met with Director, Amy Miller who accompanied LPA on a tour of the facility, and a census was taken. The purpose of today’s inspection is to address a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) from water at the facility.

Fresno Regional Office received notification that the facility has very high lead exceedance from a water lead sampling test collected on 10/11/22. LPA reviewed the following Sampling Documents with Director: LIC 9275 - External Water Sampler Self-Certification Form, LIC 999 - Facility Sketch, and LIC 9276 - Child Care Center Sampling Checklist Form with Director to identify the outlets with ALE. LPA advised Director the following sample sites contained ALE: Outlet B in Garden Classroom with 22 ppb, Outlet G in Kitchen with 20.5 ppb, and Outlet T in Toddler 3 Classroom with 11.9 ppb. LPA informed Director that the facility is out of compliance due to lead exceedance and due to not being tapped off for complete inoperability. LPA observed water outlet inoperable by shutting off the water values. LPA discussed with Director different options to bring the facility into compliance: permanently cease use of this outlet, replace the water outlet and conduct a Follow-up Corrective Action Water Sampling Test. Director stated she will tap off outlets in Toddler 3 classroom and kitchen and replace outlet in Garden classroom and conduct a Follow-up Corrective Action Water Sampling Test as outlined in Written Directives Section 101705. Director agrees to update the plan of operation with changes to the facility. Director shall notify all parents/authorized representatives of any corrective action already taken at the facility.

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

Director was provided a copy of appeal rights. An exit interview was conducted with the Director, Amy Miller.

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: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/03/2022 12:05 PM - It Cannot Be Edited


Created By: Jose Penate On 11/03/2022 at 11:29 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: CALIFORNIA IVY LEAGUE PREP ACADEMY, PS & IC
FACILITY NUMBER: 153808780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited

101700.3(b)(1)

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California Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number ... (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE). This requirement was not met as evidenced by:
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Director ceased operation of the affected water outlets by shutting off the water valves and covering the outlets with a plastic bag and tape during the inspection. Director stated she will contact a plumber to replace the fixtures within the week. Director agrees to update the plan of operation with changes to the facility.
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Based on record review, three outlets at the facility contained very high 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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Director will notify all parents/authorized representatives of any corrective action already taken at the facility. Director stated she will conduct a follow up water sample as outlined in Written Directives Section 101705 and submit all required documentation to CCL by 11/18/2022.

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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:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


LIC809 (FAS) - (06/04)
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