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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125401822
Report Date: 06/30/2022
Date Signed: 06/30/2022 04:23:09 PM

Document Has Been Signed on 06/30/2022 04:23 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HEAD START - RIO DELLFACILITY NUMBER:
125401822
ADMINISTRATOR:AMMONS, KIMFACILITY TYPE:
850
ADDRESS:95 CENTER STREETTELEPHONE:
(707) 764-3824
CITY:RIO DELLSTATE: CAZIP CODE:
95562
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/30/2022
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Naomi Faulkner/Abraxas LaytonTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/30/2022 at 9:00 AM, Licensing Program Analyst (LPA) Kiriko Lynch made a collateral inspection and met with Naomi Faulkner and Abraxas Layton. 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 faucets tested above the allowable level (5.5 ppb) of lead in the water:

Rio Dell Head Start Program –
Fixture “B” – classroom handwashing sink, 9.5 ppb

The staff have made the fixtures inaccessible by: Facility representative stated the sink faucet was removed and replaced on 01/11/2022 and was retested and passed on 04/09/2022. LPA noted that facility stated this handwashing fixture was tested due to lead tester’s discretion, and not mandated by the regulations.

The following deficiency is being cited (see LIC 809D). A 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.

Exit interview conducted and report was reviewed with the facility representatives Naomi Faulkner and Abraxas Layton.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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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Document Has Been Signed on 06/30/2022 04:23 PM - It Cannot Be Edited


Created By: Kiriko Lynch On 06/30/2022 at 12:55 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HEAD START - RIO DELL
FACILITY NUMBER: 125401822

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/01/2022
Section Cited
CCR
101238(a)

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Buildings and Grounds - 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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The licensee agrees to submit/resubmit an LIC 9275 and LIC 9276 by POC due date. The licensee has made the fixture(s) inaccessible until retested/fixed or replaced, or applicable fixture(s) have been already retested/fixed and replaced or signage posted.
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Based on record review, the facility had faucet(s) that exceeded that allowable levels of lead in the water. This is 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:Erin Virrueta
LICENSING EVALUATOR NAME:Kiriko Lynch
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022


LIC809 (FAS) - (06/04)
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