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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550317028
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:51:33 PM

Document Has Been Signed on 05/01/2024 12:51 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SONORA PM CLUBFACILITY NUMBER:
550317028
ADMINISTRATOR/
DIRECTOR:		DOREENE WOLFEFACILITY TYPE:
840
ADDRESS:830 GREENLEY ROADTELEPHONE:
(209) 694-6594
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 180TOTAL ENROLLED CHILDREN: 180CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Site Supervisor, Doreene WolfeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On May 1, 2024, Licensing Program Analyst (LPA) Lauren Scott met with Site Supervisor, Doreene Wolfe, for a Case Management inspection. The purpose of the inspection was to follow-up on a lead testing report dated 11/30/2023 which tested the water in the facility.

The report revealed that three drinking water outlets had elevated levels of lead. All outlets were physically labeled at time of inspection. Site Supervisor provided LPA a copy of the lead testing results that were retested on 04/03/2024. Site Supervisor stated all outlets that had an exceedance were replaced. All outlets no longer have a lead exceedance.

As a result of the initial outlets 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, Doreene Wolfe. 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: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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 05/01/2024 12:51 PM - It Cannot Be Edited


Created By: Lauren Scott On 05/01/2024 at 12:38 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SONORA PM CLUB
FACILITY NUMBER: 550317028

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
101238

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(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement was not met as evidenced by:
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Facility has already replaced all faucets with an exceedance and retested. No exceedances in new testing results.
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Three outlets showed lead level exceedances in the water testing conducted on 11/30/2023,

This poses 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:Chayntel Hunter
LICENSING EVALUATOR NAME:Lauren Scott
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024


LIC809 (FAS) - (06/04)
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