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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543810034
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:49:01 PM

Document Has Been Signed on 05/03/2023 12:49 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
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FAMILY F.O.C.U.S. PORTERVILLE PRESCHOOLFACILITY NUMBER:
543810034
ADMINISTRATOR:TANNER, PRUDY JFACILITY TYPE:
850
ADDRESS:1395 E OLIVE AVETELEPHONE:
(559) 793-2809
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 15DATE:
05/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Donna PascualTIME COMPLETED:
01:00 PM
NARRATIVE
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On 05/03/23 Licensing Program Analysts (LPAs) Paul Garcia and Nancy Her conducted an unannounced case management inspection. LPAs met with Dona Pascual for the purpose of conducting a case management inspection, regarding a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) in the water at the facility.

Fresno South Regional Child Care Office received notification of water lead exceedance at the facility resulting from a recent water lead sampling test. Based on records reviewed from Child Care Center Lead Sampling and Reporting Tool and self-reported information from licensee #543810034, the kitchen faucet(A) is impacted with an ALE of 7.9 ppb. This result indicates out of compliance over (ALE) 5.5 ppb. (See Plan of correction for further corrective action 809D). The kitchen outlet has temporarily been made inoperable and is in the planning stages of being repaired and retested.

Director stated children are provided bottled water regularly to provide children in care for consumption. Potable water is also made available to visitors and staff during hours of operation. Facility will post results for parents to review Per PIN 21-21-1 CCP WD 101703 (b). In addition parents and guardians will be notified by letter and verbally of the ALE per PIN 21-21-1 CCP WD 101704 (b)(3).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

Exit interview conducted and report was reviewed with the facility representative Donna Pascual.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Paul Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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 05/03/2023 12:49 PM - It Cannot Be Edited


Created By: Paul Garcia On 05/03/2023 at 12:15 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: FAMILY F.O.C.U.S. PORTERVILLE PRESCHOOL
FACILITY NUMBER: 543810034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited

101700.3

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(a) California’s Action Level for lead in water at Child Care Centers is 5 ppb.
(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. Testing results with fractional ppb readings of less than 0.5 ppb shall be rounded down to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. (2) 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. (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
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Director agrees to repair the drinking fountain and have the outlet resampled by a certified sampler. Director will provide evidence of outlet testing at or below action level to Fresno Community Care Licensing. Director agrees to notify parents and authorized representatives. Director will post ALE results at a reasonable location for Authorized Representatives to review.
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This requirement was not met evidence by: Based on record review provided by licensee indicating the kitchen outlet is impacted with an ALE of 7.9 ppb.

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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:Duane Matsubara
LICENSING EVALUATOR NAME:Paul Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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