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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617385
Report Date: 08/09/2024
Date Signed: 08/09/2024 12:47:24 PM

Document Has Been Signed on 08/09/2024 12:47 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ACE TOTS PRESCHOOLFACILITY NUMBER:
393617385
ADMINISTRATOR/
DIRECTOR:		KHAN, NADIAFACILITY TYPE:
850
ADDRESS:7204 SHORELINE DRIVETELEPHONE:
(209) 330-1030
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 90TOTAL ENROLLED CHILDREN: 31CENSUS: 19DATE:
08/09/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Khan, NadiaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On August 9th, 2024, at 10:50 AM, Licensing Program Analysts (LPAs) David Nguyen and Deborah Khashe conducted a field visit to the facility for the purpose of a Case Management inspection regarding a water report with an exceedance of lead. LPA Nguyen and LPA Khashe arrived at the facility and were met by Director, Nadia Khan. LPA Nguyen disclosed the purpose of the inspection and was granted entrance into the facility. LPA observed nineteen (19) childcare children being supervised by three (3) childcare teachers. LPA Nguyen determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

LPA Nguyen was notified of the water testing report on June 25th, 2024, via email, and required documentation was attached. The report revealed that one (1) water faucet (B) in classroom # 3 had elevated levels of lead. LPA observed that the water faucet (B) in classroom # 3 had been marked as "Not in Service/Not Used" and are inaccessible for use. Director Nadia Khan stated that children were severed water from drinking fountain (E) in the hallway, which is filtered and not affected. Director Nadia Khan also stated that childcare children brought their own water bottles from home for refilling at the drinking fountain for outdoor play and indoor. Director Nadia Khan stated that the affected faucet in classroom 3 will be replaced on Monday, August 12th, 2024. Director Nadia Khan understands that she is to notify LPA Nguyen once the water faucet (B) in Classroom # 3 is replaced, and the water is retested for lead. Director Nadia Khan will email LPA Nguyen photographs of the sink once the water faucet is replaced and the lead test results.

Report continues on LIC809-C...(Page 2)

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ACE TOTS PRESCHOOL
FACILITY NUMBER: 393617385
VISIT DATE: 08/09/2024
NARRATIVE
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(Page 2)
A Type-B deficiency was cited on subsequent LIC809-D page. An exit interview was conducted, and the report was reviewed with Director, Nadia Khan. LPA provided Licensee Appeal Rights to Director. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2024 12:47 PM - It Cannot Be Edited


Created By: David Nguyen On 08/09/2024 at 11:56 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ACE TOTS PRESCHOOL
FACILITY NUMBER: 393617385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2024
Section Cited

101700.3(b)(1)

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Lead Testing (b)(1) A result which values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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During today's visit LPA observed that the affected water faucet is not in use. Director stated that once she was informed, she took immediate action. The affected faucet will be replaced on 8/12//24, and the water will be retested.
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The water report dated 06/18/2024 revealed that the facility had elevated levels of lead in one water faucet. This is a potential health and safety risk to the children in care.
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Director will email LPA Nguyen photographs of the sink once the water faucet is replaced and the lead test result once obtained.


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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:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


LIC809 (FAS) - (06/04)
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