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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181372519
Report Date: 06/02/2022
Date Signed: 06/02/2022 10:31:22 AM

Document Has Been Signed on 06/02/2022 10:31 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:SUSANVILLE HEAD STARTFACILITY NUMBER:
181372519
ADMINISTRATOR:SWAIN, NICOLETTEFACILITY TYPE:
850
ADDRESS:195 RUSSELL AVETELEPHONE:
(530) 257-2343
CITY:SUSANVILLESTATE: CAZIP CODE:
96130
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: DATE:
06/02/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Nicolette SwainTIME COMPLETED:
10:10 AM
NARRATIVE
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On 6/2/22, at 9:25 am, Licensing Program Analyst (LPA) Wisehart made a case management inspection and met with Director, Nicolette Swain. 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:

Faucet “B” – Sink Faucet, Toddler Classroom, 25 ppb

The faucet is used for hand washing only and a sign has been placed near the sink notifying users that it’s not drinkable water. The licensee replaced the faucet and is pending a retest date on 6/13/22. Children in care are receiving drinking water from water juggle/cups filled up in kitchen.

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 Director, Nicolette Swain.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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 06/02/2022 10:31 AM - It Cannot Be Edited


Created By: Carrie Wisehart On 06/02/2022 at 06:01 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: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
07/04/2022
Section Cited
CCR
101238(a)

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Buildings and Grounds 101238(a) 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 an LIC 9275 and LIC 9276 by 6/27. The licensee posted a sign above the handwashing faucet. The licensee replaced the faucet piece and it will be retested on 6/13/22. Retesting documents will be submitted within 2 weeks of the completed sampling or by June 27th.


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Based on record review, the facility had 1 faucet 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:Megan Aviles
LICENSING EVALUATOR NAME:Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022


LIC809 (FAS) - (06/04)
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