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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203808857
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:41:11 PM

Document Has Been Signed on 10/20/2022 02:41 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WILSON PRE-K AND FAMILY LITERACYFACILITY NUMBER:
203808857
ADMINISTRATOR:MENDEZ, NARACELIFACILITY TYPE:
850
ADDRESS:1209 ROBERTSON BLVDTELEPHONE:
5596623821
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 5DATE:
10/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Naraceli Mendez - Site SupervisorTIME COMPLETED:
02:45 PM
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On 10/20/22 Licensing Program Analysts (LPAs) Joseph Pacheco and Araceli Gibson conducted an unannounced case management inspection. LPA met with Site Supervisor, Naraceli Mendez. The purpose of today's inspection is to discuss 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.

The Fresno Regional Office, Community Care Licensing, received notification from Licensee, Madera County Superintendent of Schools District on 10/17/22 of water lead exceedance at the facility resulting from a recent water lead sampling testing conducted on 9/21/22 by Moore Twining Associates Inc. According to the report provided by Licensee, outlet B had an ALE of 18 ppb. Licensee submitted the following Plan of Correction:

· Outlets removed from Service - The use of Outlet B for drinking and food preparation has ceased immediately on 10/10.22.
· Notification provided – Testing results were posted at the facility on 10/13/22, within 72 hours of receipt of testing results.
· Alternative drinking water sources provided – Drinking water is being provided only from sinks and drinking fountains on site that have been tested and confirmed to be below the Action Level for lead.
· Replacement of fixtures – The identified fixtures with Action Level exceedances were replaced on 10/11/22. The fixture was replaced with a Glacier Bay Clare Single Handle Pull Down Laundry Utility Faucet, which is a certified low-lead fixture, based on the guidance from the ELAP document “How to Identify Lead Free Certification Marks for Drinking Water System & Plumbing Products. The new fixture will be turned on for at least 30 seconds, at least 4 times a day, for at least 3 weeks prior to follow-up sampling, in accordance with AB2370 protocols. The flushing process will be tracked on a sheet posted next to the new outlet.
CONTINUED ON 809-C
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WILSON PRE-K AND FAMILY LITERACY
FACILITY NUMBER: 203808857
VISIT DATE: 10/20/2022
NARRATIVE
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· Follow-up testing – Per AB2370, outlets that have been replaced as part of the Plan of Correction will be sampled by a certified third-party sampler after fixture replacement and conditioning to ensure that results are at or below the Action Level prior to using the outlet for drinking or food preparation. The follow-up testing is tentative scheduled for November 2, 2022. Parent/guardians will be notified upon receipt of the results of follow-up testing (approximately 2 weeks from follow-up sampling.

During today’s inspection, LPA observed that facility informed parents of the ALE through the Bright Wheel communication app. LPA also observed a fixture flushing log for outlet B. Site Supervisor stated that facility is utilizing a pitcher with water from the Wilson Middle School cafeteria as an alternative water source.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). An exit interview was conducted with Site Supervisor, Naraceli Mendez and she was provided a copy of this report, along with appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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Document Has Been Signed on 10/20/2022 02:41 PM - It Cannot Be Edited


Created By: Joseph Pacheco On 10/20/2022 at 02:03 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: WILSON PRE-K AND FAMILY LITERACY
FACILITY NUMBER: 203808857

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2022
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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Authorized representatives have been notified. A sign was placed next to the outlet identifying it as being temporarily out of service. The outlet was replaced with a certified low-lead fixture.
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This requirement was not met evidence by: Based on record review provided by Moore Twining Associates, Inc., outlet B in the facility tested over the allowable ALE 5.5 ppb. This poses a potential health, safety or personal rights risk to persons in care.
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 The flushing process is being tracked on a sheet posted next to the outlet. Follow-up testing of Outlet B is tentatively scheduled for 11/2/22. Licensee to submit documentation of evidence of at or below action level to community Care Licensing by 11/21/22.

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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:Diana deLeon
LICENSING EVALUATOR NAME:Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


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