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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065405229
Report Date: 02/15/2023
Date Signed: 02/15/2023 11:19:39 AM

Document Has Been Signed on 02/15/2023 11:19 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:ARBUCKLE EARLY CARE & EDUCATION CENTERFACILITY NUMBER:
065405229
ADMINISTRATOR:MARKSS, VICKIFACILITY TYPE:
850
ADDRESS:620 GAIL AVENUETELEPHONE:
(530) 476-2866
CITY:ARBUCKLESTATE: CAZIP CODE:
95912
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 16DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Itsageri Ruiz, TeacherTIME COMPLETED:
11:20 AM
NARRATIVE
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On 2/15/2023 at 9:40am, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with Teacher Itsageri Ruiz,. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucet tested above the allowable level (5.5 ppb or greater) of lead in the water:

Faucet “B” – outdoor sink, 40ppb

The outdoor sink is used for hand washing only. Children in care are receiving drinking water a drinking fountain in the classroom and from an Igloo filled with water for outdoors.

The following deficiency is being cited (see LIC 809D). Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with facility representative, Itsageri Ruiz, Teacher.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 11:19 AM - It Cannot Be Edited


Created By: Laura Chavez On 02/15/2023 at 10:42 AM
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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: ARBUCKLE EARLY CARE & EDUCATION CENTER
FACILITY NUMBER: 065405229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by: a record review, the facility has 1
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The sink has been labeled "Hand Washing Only".
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outdoor sink with lead test results at or exceeding 5.5 ppb of lead in the water.

This is a potential health and safety risk to children in care.
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Type B
03/01/2023
Section Cited
CCR101703

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 Post -Testing Requirements and Information

This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form.
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The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form.

The plan of correction shall be submitted to CCLD on or before 3/1/2023.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Laura Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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