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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624777
Report Date: 08/13/2024
Date Signed: 08/13/2024 01:38:32 PM

Document Has Been Signed on 08/13/2024 01:38 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:AMERICAN LEGION CHILDREN CENTERFACILITY NUMBER:
343624777
ADMINISTRATOR/
DIRECTOR:		ESTACIO, NOELFACILITY TYPE:
830
ADDRESS:3801 BROADWAYTELEPHONE:
(916) 643-9413
CITY:SACRAMENTOSTATE: CAZIP CODE:
95817
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Suzie VangTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer Velasco met with Facility Representative, Suzie Vang (Representative to conduct an unannounced case management inspection regarding lead testing. The purpose of today's inspection was to notify staff of and document a plan of correction following reports of lead exceedance in two of the facility outlets. On 01/28/2023, the facility tested water samples for lead. Lead testing identified two water outlets that have Action Level Exceedance (ALE) of lead over the amount of 5.5 parts per billion (ppb).

The water outlet designated as outlet A has an exceedance of 14 ppb. Representative stated water outlet A is in Infant Room One and is used for handwashing. Representative stated water outlet A is not used for drinking or food preparation and will not be used at all until replacement parts are installed and retesting has been conducted to ensure there is no ALE. During today's inspection, Representative covered outlet A with a trash bag taped to it so staff would not use it.

The water outlet designated as outlet C has an exceedance of 8.4 ppb. Representative stated outlet C is in the kitchen and will not be used until replacement parts are installed and lead testing has been conducted again to ensure no there is no ALE. Representative stated filtering water pitchers will be filled from an outlet that did not have an ALE. During today's inspection, Representative covered outlet C with a trash bag taped to it so staff would not use it. Representative stated food is prepared by the school district and transported to the facility.

A deficiency is cited on the subsequent page (LIC 809D) of this report and is considered a potential threat to the health and safety of children in care. An exit interview was conducted with the Facility Representative. LPA provided Appeal Rights and a Notice of Site Visit that must be posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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 08/13/2024 01:38 PM - It Cannot Be Edited


Created By: Jennifer Velasco On 08/13/2024 at 12:59 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: AMERICAN LEGION CHILDREN CENTER
FACILITY NUMBER: 343624777

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
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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Usage of the faucets was stopped immediately upon receiving the results. Facility Representative stated the faucets will not be used pending a work order to replace parts and clearance by retesting. Alternate water is available from other sources that have not tested in exceedance.
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Based on record review, two water outlets tested for lead exceeded the allowed 5.5 ppb, which poses/posed a potential health, safety, and/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:Natalie Dunaway
LICENSING EVALUATOR NAME:Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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