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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500377
Report Date: 03/01/2023
Date Signed: 03/01/2023 12:48:44 PM

Document Has Been Signed on 03/01/2023 12:48 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KIDS PLACE 2 EXPLORE & LEARN LLCFACILITY NUMBER:
394500377
ADMINISTRATOR:CARINA DIAZ DE BARAJASFACILITY TYPE:
850
ADDRESS:9371 N. LOWER SACRAMENTO ROADTELEPHONE:
(209) 478-6161
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 31DATE:
03/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Director: Carina DiazTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Mariya Melnichuk met with Director Carina Diaz for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 02/08/2023 which tested the water in the facility. LPA verified that all required adults have a clear background check by accessing guardian.

LPA was notified of the lead testing report which was dated 02/08/2023. The report revealed that one water outlet had elevated levels of lead. LPA observed that the faucet is located outside and has a faucet cover. Director stated that she will cap off the water pipe of the faucet and make it inaccessible to children

As a result of the water testing positive for lead, a deficiency was cited on a subsequent page, 809D. An exit interview was conducted and the report was reviewed with Site Supervisor. A Notice of Site visit was posted by LPA and must remain posted 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: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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 03/01/2023 12:48 PM - It Cannot Be Edited


Created By: Mariya Melnichuk On 03/01/2023 at 12:04 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: KIDS PLACE 2 EXPLORE & LEARN LLC
FACILITY NUMBER: 394500377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/01/2023
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 outlet is not in use. Director will shut off the faucet and send photo to LPA by 4/01/2023.
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The water report dated 02/08/2023 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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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:Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023


LIC809 (FAS) - (06/04)
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