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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407064
Report Date: 06/29/2023
Date Signed: 06/29/2023 10:56:19 AM

Document Has Been Signed on 06/29/2023 10:56 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:GREAT ADVENTURESFACILITY NUMBER:
455407064
ADMINISTRATOR:ROBERTS, PATRICIAFACILITY TYPE:
850
ADDRESS:2220 BALLS FERRY ROADTELEPHONE:
(530) 378-5720
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 19DATE:
06/29/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Patricia RobertsTIME COMPLETED:
11:05 AM
NARRATIVE
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On 6/29/23 at 10:19am, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Center director Patricia Roberts. 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 “B” – exterior drinking fountain, 7 ppb

The staff have made the faucet inaccessible by removing drinking spout from outlet making it inaccessible. Children in care are receiving drinking water from kitchen sink and they use a water pitcher to provide water for children.

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 Patricia Roberts.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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 06/29/2023 10:56 AM - It Cannot Be Edited


Created By: Bianca Mendez On 06/29/2023 at 10:26 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: GREAT ADVENTURES
FACILITY NUMBER: 455407064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
Section Cited
HSC
101700.3(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:

The licensee has made the faucet inaccessible by disconnecting drinking spout from outlet
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The center director agrees to submit an LIC 9275 and LIC 9276 by 7/7/23. The center director removed spout from drinking outlet from the playground.
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Based on record review, the facility had Faucet B 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: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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