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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370087
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:30:26 AM

Document Has Been Signed on 04/14/2023 10:30 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PLACENTIA HEAD STARTFACILITY NUMBER:
304370087
ADMINISTRATOR:SMITH, KIMFACILITY TYPE:
850
ADDRESS:840 SOUTH MELROSETELEPHONE:
(714) 632-8787
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 340DATE:
04/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Manuel Gomez TIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA), Dianna Valdez Santana conducted an unannounced Case Management visit for the purpose to discuss the Lead Sampling Testing conducted on 03/11/2023. LPA met with Center Director, Manuel Gomez, who was explained the reason for today’s visit. LPA observed 34 children in care at the time of visit.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

Community Care Licensing was notified that lead water testing conducted at the facility on 03/11/2023 failed allowable limit for lead. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE).

Instructions for required lead testing are outlined in PIN 21-21-CCP. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

Child Care Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in parts per billion (ppb) unit of measurement.


Facility staff was advised on 04/12/2023 that the Lead Sample Report was to be posted. LPA did observe the facility had posted the Lead Sample Report.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PLACENTIA HEAD START
FACILITY NUMBER: 304370087
VISIT DATE: 04/14/2023
NARRATIVE
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Outlet B tested positive for elevated levels of lead. The outlet is a kitchen station sink located inside the kitchen and had a level of 20.000. Currently the site does not have a sign that reads "Do Not Use" because the outlet has been permanently capped off and will no longer be in use. Outlet C is a water boiler faucet located in the kitchen near the refrigerators. Outlet C also tested positive for high levels of lead and had a level of 8.560. The outlet has been made inaccessible with a sign that says, “Do Not Use”. The facility utilizes "Brita" water pitchers in each classroom and water from the sinks that passed with no excess levels of lead as alternate water sources.

Based on LPA's interview with staff, review of facility sketch and walk-through, the following violation was observed and is being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 3, Section 101700.3 California Lead Action Level at Child Care Centers is being cited on the attached LIC 809D.



Exit interview conducted with facility representative. The report was reviewed and discussed. Appeal Rights were discussed. Director was provided copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received the Regional Office within 15 business days.

Director was informed that the "Notice of Site Visit" must be posted for 30 consecutive days. The Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

Page 2 of 2. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/14/2023 10:30 AM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 04/14/2023 at 09:53 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PLACENTIA HEAD START
FACILITY NUMBER: 304370087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2023
Section Cited

101700.3(b)

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101700.3 (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.
(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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During visit, LPA confirmed lead results were posted. Facility will replace and retest outlet C and will submit results and the requested documents to LPA via email at dianna.valdezsantana@dss.ca.gov.
Outlet B has been permanently capped off.
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This requirement is not met evidenced by: record review of the lab report analysis from Outlet B and Outlet C taken on 3/11/2023. Outlet B tested 20.000 ppb. Outlet C tested 8.560 ppb. Results indicated levels of lead in exceedance. This poses a potential risk to the health and safety of children in care.
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Facilty provides water through Brita water pitchers and water from sinks from that did not test positive for elevated levels of lead. Parent notification was sent on 4/13/23 via app "Learning Genie".

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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:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023


LIC809 (FAS) - (06/04)
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