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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317922
Report Date: 08/29/2024
Date Signed: 08/29/2024 02:20:43 PM

Document Has Been Signed on 08/29/2024 02:20 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LEATAATA FLOYD PRESCHOOLFACILITY NUMBER:
340317922
ADMINISTRATOR/
DIRECTOR:		CLAR, RAMANFACILITY TYPE:
850
ADDRESS:401 MCCLATCHY WAYTELEPHONE:
(916) 643-7801
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
08/29/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Clar, RamanTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On Thursday, August 29th 2024, Licensing Program Analyst (LPAs) Pa Dao Vang and Amanda Sutter met with Director, Raman Clar, to conduct an unannounced case management. The purpose of today's inspection was to create a plan of correction following a report of lead exceedance in facility outlet. Upon arrival, LPAs were provided with the LIC9275 and LIC9276.

On 1/4/2023, the facility tested water sample for lead. One water outlet sampled indicated an Action Level Exceedance (ALE). The outlet that tested in exceedance is sink faucet D located in the office/kitchen at 8.6ppb. Director explained the sink faucet D is only used for staff washing their own dishes from home during breaks. It’s not used for food preparing or children's consumption. The facility was notified that water lead levels were in exceedance of 5.5 parts per billion and that corrective actions are being taken.

The outlets A, B, and C included sinks and water fountains located inside the classroom. These are used for children's consumption and hand-washing.

A plan of correction is being issued to ensure the outlet is made inoperable, removed, and/or replaced. All other faucets used by preschool children have been tested and are not in Action Level Exceedance. Director will connect with the school district to decide to either cap off the tap or to replace and retest the outlet. Director will also email completed copies of the LIC9275 and LIC9276 forms to LPA.

LPA informed Licensee Representative of Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP.

A deficiency is cited on the following LIC809-D page and the plan of correction was reviewed with the Director, Raman Clar. An exit interview was conducted with Director Raman Clar. A copy of this report and appeal rights were also provided, as well as a notice of site visit which much remain posted for 30 consecutive days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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 08/29/2024 02:20 PM - It Cannot Be Edited


Created By: Dao Vang On 08/29/2024 at 01:50 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LEATAATA FLOYD PRESCHOOL
FACILITY NUMBER: 340317922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement is not met as evidenced by:
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Tap in exceedence is not used for drinking water and is in a room inaccessible to children. Facility will choose to either cap off the tap or to replace and retest the outlet. Lead Teacher will also email completed copies of the LIC9275 and LIC9276 forms, and notify LPA their decision.
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Based on observation, the licensee did not comply with the section cited above with outlet D over exceedance of 8.6ppb, which posed a potential health, safety or personal rights risk to persons in care.
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 Facility will notify all parents of exceedence and remediation plan.

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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Dao Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
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