<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330908048
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:25:11 PM

Document Has Been Signed on 11/10/2022 02:25 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SAN JACINTO CHILD CARE CENTERFACILITY NUMBER:
330908048
ADMINISTRATOR:KIMBERLY DAYFACILITY TYPE:
850
ADDRESS:1499 N. STATE EAGLE ROAD #2100TELEPHONE:
(951) 487-3613
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 124TOTAL ENROLLED CHILDREN: 71CENSUS: 45DATE:
11/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kimberly Day, DirectorTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On November 10, 2022 at 9:00am, Licensing Program Analyst (LPA) Lorena Valenzuela made an unannounced case management inspection due to reported Lead Exceedance in the facility’s water. LPA met with Director Kimberly Day and proceeded to tour the facility. Present in the facility were 45 day care children and 11 teachers/staff. Facility was within ratio & capacity.
Per interview and records review, the facility had the water sampled for lead on 06/25/2022. Per the director, as soon as they received the water sample report on 07/12/2022, the facility ceased use of the water outlets with lead exceedance. After the water sample results, the faucets and sinks with Action level exceedance that needed replacement were replaced between 07/03/2022 and 08/25/2022.
During the inspection, facility provided LPA with facility sketch, signed and dated External Water Sampler Self- Certification (LIC 9275) and Child Care Sampling Checklist (LIC 9276) forms along with reports provided by the external water sampler. Parents were notified via the parent communication board in the lobby where the latest lead test results are posted.

Based on the initial water sample taken on 06/25/2022, water outlets reported 5.5 ppb (parts per billion) or greater lead exceedance levels as follows:
Room 3- Bubbler South, labeled letter F - 30.00 ppb
Room 4- Faucet Front, labeled letter I- 6.80 ppb
Room 4- Bubbler Back, labeled letter J- 16.00 ppb
Room 4- Faucet back, labeled letter K- 6.3 ppb
Room 6- Bubbler, labeled letter L- 19.00 ppb
Room 6- Faucet, labeled letter M- 18.00 ppb
Room 7- Bubbler, labeled letter N- 28.00 ppb
Room 7- Faucet, labeled letter O- 21.00 ppb
Kitchen faucet, Right, labeled letter Q- 15.00 ppb
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SAN JACINTO CHILD CARE CENTER
FACILITY NUMBER: 330908048
VISIT DATE: 11/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed the Director and observed the water faucets and drinking fountains with an Action Level Exceedance. Per staff interview, kitchen faucet (labelled letter Q) was being used to wash vegetables and for food preparation for the children in care. Room 3 is being used by toddlers, at time of inspection 10 children were present. Interview conducted with staff in Room 3, indicated they had been using bubbler labelled letter D to provide water to the children and well as refill the childrens' water containers. Per director some teachers provide water bottles and water cups for students who forget to bring their own water.
Per interview and records review, a second water sample was taken after the faucet and sinks have been replaced. The water was sampled on 10/01/2022, and the facility received the results on 10/17/2022.
Based on the water sample taken on 10/01/2022, the results indicated water outlets reported 5.5 ppb (parts per billion) or greater lead exceedance levels as follows:

Room 3- Bubbler South, labeled letter F – 11.00 ppb
Room 4- Bubbler Back, labeled letter J- 13.00 ppb
Room 6- Bubbler, labeled letter L- 8.3 ppb
Room 7- Bubbler, labeled letter N- 16.00 ppb

During the facility inspection, LPA observed the water outlets labelled F, J, L, N, with “do no use signs” and covered. Per interview and records review, the water outlets labelled (F, J, L, N) have had the angle stops and supply lines replaced. Director indicated she is currently following the 3 week flushing procedures and anticipates the next water sample test will occur on 10/19/2022. Per the director, she has sent a purchasing order for the water sampling and is pending approval.
In addition, all staff members do not have the required background clearances. Per interview and record review, Staff #1 (S1) has been working in the facility since 2002 and documentation reviewed indicated S1 had a background clearance. However, LPA reviewed the Department's background clearances and associations and S1 and has been disassocated from the facility since 2013. Per director, the college campus in which the facility is located is required to fingerprint all staff working in the campus.

See deficiency reports, LIC809D for cited deficiencies. A civil penalty has been assessed.

LPA Valenzuela informed Director Kimberly Day that this report dated 11/10/2022 documents one Type A citation. A Type A citation(s) shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 11/10/2022 02:25 PM - It Cannot Be Edited


Created By: Lorena Valenzuela On 11/10/2022 at 12:28 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN JACINTO CHILD CARE CENTER
FACILITY NUMBER: 330908048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/28/2022
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
101700.3 (b) (1) Written Directives...A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Director agrees to submit results of the water sample test that is tentatively scheduled to occur on 10/19/2022, director will submit to the Department by due date 11/28/2022.
8
9
10
11
12
13
14
Based on water testing results, interviews and records review, facility tested over the Action Level Exceedance, in several water outlets used for drinking water and one kitchen sink used for food preparation. This poses a potential health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Stephanie Hudak
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 11/10/2022 02:25 PM - It Cannot Be Edited


Created By: Lorena Valenzuela On 11/10/2022 at 01:14 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN JACINTO CHILD CARE CENTER
FACILITY NUMBER: 330908048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2022
Section Cited
CCR
101170(e)(1)

1
2
3
4
5
6
7
101170 (e) (1) Criminal Record Clearance. All individuals subject to a criminal record review...shall prior to working, in a licensed facility: Obtain a California clearance...as required by the Department…
This requirement was not met as evidence
1
2
3
4
5
6
7
Director agrees to submit documentation that the facility is ensuring S1 gets the background check process started or completed live scan form for Staff #1 to the Department by due date 11/14/2022.
8
9
10
11
12
13
14
Based on interview and records review, Staff #1 (S1) has been working at the facility since 2002. Per review of the Department's background check database S1 was disassocated in 2013 and S1 does not show a current clearance on file. This poses an immediate health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Stephanie Hudak
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SAN JACINTO CHILD CARE CENTER
FACILITY NUMBER: 330908048
VISIT DATE: 11/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Also, LPA Valenzuela informed Director Kimberly Day to provide a copy of this licensing report dated 11/10/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed, a copy of appeal right and report were provided to Director Kimberly Day. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5