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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125408207
Report Date: 06/20/2024
Date Signed: 06/20/2024 09:45:38 AM

Document Has Been Signed on 06/20/2024 09:45 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HUMBOLDT COUNTY OFFICE OF EDUCATION - SPECIAL BEGFACILITY NUMBER:
125408207
ADMINISTRATOR/
DIRECTOR:		HUGHES, MICHAELFACILITY TYPE:
850
ADDRESS:901 MYRTLE AVETELEPHONE:
(707) 540-5692
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kelly LoveTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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On 06/20/2024 at 9:00 AM, Licensing Program Analyst (LPA) Noah Wheeler made a case management inspection and met with Program Manager Kelly Love (PD). 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 ppb) of lead in the water:

Staff Break Room, Faucet “A” – break room sink, 112.0 ppb

The PD has made the faucet inaccessible by not using the faucet as it is in an adjacent non-licensed room that Facility staff was using to clean dishes and fill a water filtration system. The PD plans to cease use of the faucet in the Staff Break Room. Children in care are receiving drinking water from store bought bottled water.

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 Program Manager Kelly Love.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Noah Wheeler
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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 06/20/2024 09:45 AM - It Cannot Be Edited


Created By: Noah Wheeler On 06/20/2024 at 09:37 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: HUMBOLDT COUNTY OFFICE OF EDUCATION - SPECIAL BEG
FACILITY NUMBER: 125408207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited

101700.3(b)(2)

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101700.3(b)(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. This requirement was not met as evidenced by:
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The licensee has made the faucet inaccessible by ceasing use of the faucet. The licensee agrees to permanently stop the use of the faucet in the Staff Break Room.
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Based on record review, the facility had one faucet with lead test results exceeding 5 ppb 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:Noah Wheeler
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024


LIC809 (FAS) - (06/04)
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