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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553616866
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:39:31 AM

Document Has Been Signed on 09/22/2022 11:39 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:AMADOR-TUOLUMNE COMM.ACTION-BLUE BELL FAMILY CTRFACILITY NUMBER:
553616866
ADMINISTRATOR:KRISTEN YOUNGMANFACILITY TYPE:
850
ADDRESS:18080 BLUE BELL ROAD EASTTELEPHONE:
(209) 533-1397
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Family Resource Advocate Leeco ThachTIME COMPLETED:
11:50 AM
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On September 22, 2022, LPAs (Licensing Program Analyst) Lauren Scott and Tiffanie Diep met with Family Resource Advocate, Leeco Thach, for the purpose of a case management inspection related to elevated levels of lead in the water.

The Regional Office was notified of the elevated levels of lead in the facility's water on 08/17/2022. LPAs checked the faucet areas where the exceedance occurred (outlets B and E). These faucets are located in the preschool classroom. When LPAs toured the facility and tested the two faucets, the outlets were inoperable and had been shut off. Facility stated the water has not been used since 2020. The exact date is unknown. Director Jackie Roberts stated via e-mail she was still waiting on the physical lead testing results and would send them to CCLD once received. Due to the outlets being inoperable, LPAs determined there was no risk to the health and safety of children in care. Therefore, no citations will be issued at this time.

An exit interview was conducted and the report was reviewed with Family Resource Advocate, Leeco Thach. A Notice of Site visit was posted by LPAs and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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