<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570303946
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:59:54 PM

Document Has Been Signed on 03/22/2023 02:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:WINTERS PARENT NURSERY SCHOOLFACILITY NUMBER:
570303946
ADMINISTRATOR:GWENDOLYN ADAMSFACILITY TYPE:
850
ADDRESS:208 FOURTH STREETTELEPHONE:
(530) 795-4659
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
03/22/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Gwen AdamsTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Salene Mayberry met with Director, Gwen Adams for an unannounced Case Management Inspection. LPA observed 13 children being cared for by three staff members.

The purpose of today’s inspection was to follow up regarding a water sampling that indicated Action Level Exceedance (ALE) in an outlet tested for lead levels on 3/4/2023. On 03/13/2023, the facility was notified that water levels were in exceedance of 5 parts per billion in a kitchen faucet.

Since receiving the notification Director advised they have replaced the outlet with the exceedance and are waiting the required amount of time to have it retested. Director indicated that they only use the outlet for washing dishes and cleaning; however, they will not use the outlet until it is retested and determined to be safe. Director advised LPA that they have Alhambra water available for drinking water. During today’s visit LPA confirmed that the outlet had been replaced. LPA informed Director that Grant funding for testing and remediation is available and that information could be found in Provider Information Notice (PIN) 21-04-CCP.

A Type B deficiency was cited on the subsequent page (LIC809-D) of this report.

An Exit interview conducted, and the report was reviewed and provided to Director. LPA posted the Notice of Site Visit and Director acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/22/2023 02:59 PM - It Cannot Be Edited


Created By: Salene Mayberry On 03/22/2023 at 02:48 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: WINTERS PARENT NURSERY SCHOOL
FACILITY NUMBER: 570303946

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited

101700.3(c)

1
2
3
4
5
6
7
101700.3 California Lead Action Level at Child Care Centers (c) If testing indicates an...Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response...shall be required. This requirement was not as evidenced by:
1
2
3
4
5
6
7
LPA visually observed that the facility had replaced the outlet. Director will have the outlet retested and provide Licensing with a copy of the report. Director also indicated that they will not use the outlet until it is retested and determined to be safe.
8
9
10
11
12
13
14
Lead test results received by Licensing on 3/13/2023, tested on 3/4/2023, showed an outlet in the facility had lead levels exceeding 5 parts per billion (ppb). This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Bettina Engelman
LICENSING EVALUATOR NAME:Salene Mayberry
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2