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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455402120
Report Date: 04/08/2024
Date Signed: 04/08/2024 09:21:12 AM

Document Has Been Signed on 04/08/2024 09:21 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:MEADOW LANE STATE PRESCHOOLFACILITY NUMBER:
455402120
ADMINISTRATOR/
DIRECTOR:		HUNTER, KIMFACILITY TYPE:
850
ADDRESS:2770 BALLS FERRY ROADTELEPHONE:
(530) 378-7030
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 36DATE:
04/08/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Tamara KendallTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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On 4/8/24 at 8:52am, Licensing Program Analyst (LPA) Bianca Mendez made a case management inspection and met with facility representative, Tamara Kendall. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water:
Faucet “A” – tested at 10.00ppb, faucet is located in the classroom 26.

The faucet was replaced and retested and that the children do not have access to classroom 26 because it is currently not in use. Children currently drink water from their the other classroom faucet.


The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Tamara Kendall
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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 04/08/2024 09:21 AM - It Cannot Be Edited


Created By: Bianca Mendez On 04/08/2024 at 09:06 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEADOW LANE STATE PRESCHOOL
FACILITY NUMBER: 455402120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
HSC
101700(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement was not met as evidenced by:
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Based on record documentation Faucet A was replaced and retested and results were re-submitted. The classroom is not in use for children.
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Based on record review, the facility had faucet A with lead test results exceeding 5 ppb of lead in the water. This is a potential health and safety risk to 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:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


LIC809 (FAS) - (06/04)
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