GRACE LUTHERAN SCHOOL

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 02/22/2023 Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection. LPA met with Business Administrator, Cindy O'Halloran, who accompanied LPA on a tour of the facility. The purpose of today’s inspection is to address a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) from water at the facility. Fresno Regional Office (FRO) received notification that the facility has a high lead exceedance from a water lead sampling test collected on 1/16/2023. Based on records reviewed from the Child Care Center Lead Sampling and Reporting Tool, one outlet (Outlet D) shows an ALE of 18 ppb. Based on LPA's observation, the facility has made the outlet inoperable, and is planning on permanently removing the outlet. The facility is providing alternative potable water via filtered water dispenser to children, visitors, and staff during hours of operation. Licensee has agreed to post results on the parent board for review per PIN 21-21.1-CCP Written Directives (WD) 101703(b). In addition, parents and guardians will be notified of the ALE via letter, Per PIN 21-21.1-CCP WD 101704 (b)(3). Licensee submitted the following documents to FRO: Facility Sketch (LIC 999) for both indoor and outdoor areas, Child Care Center Sampling Checklist form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275). During the inspection, LPA obtained a copy of the lead testing report conducted by Enthalpy Analytical. The facility has agreed to continue with permanently removing the outlet. Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights. An exit interview was conducted with Business Administrator. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. SUPERVISORS NAME: Rene Mancinas LICENSING EVALUATOR NAME: Jeovanna Yanez LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023 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 FACILITY NAME: GRACE LUTHERAN SCHOOL FACILITY NUMBER: 500305696 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/22/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/22/2023 Section Cited 101700.3 1 2 3 4 5 6 7(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.1 2 3 4 5 6 7Licensee ceased operation of the affected outlet. Licensee will schedule to permanently remove the outlet. Updated plan of operation with changes to the facility will be submitted. Licensee will notify parents/authorized representatives of ALE and corrective action being taken. Licensee will post results on 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on record review, the facility had an ALE of 10 ppb in Outlet A, which poses a potential health, safety or personal rights risk to persons in care.8 9 10 11 12 13 14parent board. All required documentation to be submitted to CCL by POC Due Date. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Rene Mancinas LICENSING EVALUATOR NAME:Jeovanna Yanez LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 02/22/2023 Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection. LPA met with Business Administrator, Cindy O'Halloran, who accompanied LPA on a tour of the facility. The purpose of today’s inspection is to address a lead exceedance referred to as an Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb) from water at the facility. Fresno Regional Office (FRO) received notification that the facility has a high lead exceedance from a water lead sampling test collected on 1/16/2023. Based on records reviewed from the Child Care Center Lead Sampling and Reporting Tool, one outlet (Outlet D) shows an ALE of 18 ppb. Based on LPA's observation, the facility has made the outlet inoperable, and is planning on permanently removing the outlet. The facility is providing alternative potable water via filtered water dispenser to children, visitors, and staff during hours of operation. Licensee has agreed to post results on the parent board for review per PIN 21-21.1-CCP Written Directives (WD) 101703(b). In addition, parents and guardians will be notified of the ALE via letter, Per PIN 21-21.1-CCP WD 101704 (b)(3). Licensee submitted the following documents to FRO: Facility Sketch (LIC 999) for both indoor and outdoor areas, Child Care Center Sampling Checklist form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275). During the inspection, LPA obtained a copy of the lead testing report conducted by Enthalpy Analytical. The facility has agreed to continue with permanently removing the outlet. Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights. An exit interview was conducted with Business Administrator. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. SUPERVISORS NAME: Rene Mancinas LICENSING EVALUATOR NAME: Jeovanna Yanez LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023 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 FACILITY NAME: GRACE LUTHERAN SCHOOL FACILITY NUMBER: 500305696 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/22/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/22/2023 Section Cited 101700.3 1 2 3 4 5 6 7(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.1 2 3 4 5 6 7Licensee ceased operation of the affected outlet. Licensee will schedule to permanently remove the outlet. Updated plan of operation with changes to the facility will be submitted. Licensee will notify parents/authorized representatives of ALE and corrective action being taken. Licensee will post results on 8 9 10 11 12 13 14This requirement was not met as evidenced by: Based on record review, the facility had an ALE of 10 ppb in Outlet A, which poses a potential health, safety or personal rights risk to persons in care.8 9 10 11 12 13 14parent board. All required documentation to be submitted to CCL by POC Due Date. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Rene Mancinas LICENSING EVALUATOR NAME:Jeovanna Yanez LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023