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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343606979
Report Date: 02/01/2023
Date Signed: 02/01/2023 09:02:13 AM

Document Has Been Signed on 02/01/2023 09:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:B.J. JORDAN CHILD CARE-DRY CREEKFACILITY NUMBER:
343606979
ADMINISTRATOR:SMITH, ERIKAFACILITY TYPE:
850
ADDRESS:1230 G STREETTELEPHONE:
(916) 991-4756
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 13DATE:
02/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Erica Smith TIME COMPLETED:
09:30 AM
NARRATIVE
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On 02/01/2023, Licensing Program Analysts (LPAs) Amanda Blesi and Mandi Goodwin met with Licensing Representative Erica Smith for an unannounced Case Management Inspection. Upon arrival, LPAs observed 13 children supervised by three staff members.

On 10/19/2022, a water sample taken from a fountain located outside the classroom was collected and tested for the presence of lead. The test results indicated lead values of 5.6 parts per billion (pbb), exceeding the recommended 5.5 pbb. The water fountain was previously used for consumption, however, they made it inaccessible during the COVID-19 Pandemic and have not used it since then. When the facility was notified of the test results they immediately removed the fountain. Facility provides water by using pitchers and cups. There are other faucets that available for cooking and washing hands.

Deficiencies are cited on the subsequent page of the report per written directives 101700.3 (b)(1). See LIC 809-D.

An exit interview was conducted with the Licensing Representative. The facility has posted the report indicating the results. LPA provided licensing representative with Appeal Rights, and a Notice of Site Visit that must be posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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 02/01/2023 09:02 AM - It Cannot Be Edited


Created By: Amanda Blesi On 02/01/2023 at 08:53 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: B.J. JORDAN CHILD CARE-DRY CREEK
FACILITY NUMBER: 343606979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/08/2023
Section Cited

101700.3(b)(1)

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) ... "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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The drinking fountain was removed from the facility. The deficiency is corrected.
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Test results indicated an Action Level Exceedance (ALE) of 5.6 ppb in samples collected from the drinking fountain on the playground which posed a potential health, safety, or personal rights risk to children in care if not corrected
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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:Keven Peters
LICENSING EVALUATOR NAME:Amanda Blesi
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
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