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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910496
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:27:38 PM

Document Has Been Signed on 04/25/2024 01:27 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 HEADSTART/STATE PRESCHOOLFACILITY NUMBER:
330910496
ADMINISTRATOR/
DIRECTOR:		ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:257 GRAND ARMYTELEPHONE:
(951) 654-1531
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 82TOTAL ENROLLED CHILDREN: 82CENSUS: DATE:
04/25/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Elizabeth ZaragozaTIME VISIT/
INSPECTION COMPLETED:
01:35 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 April 25, 2024 at 12:58 PM, Licensing Program Analyst (LPA) Cindy Hamilton, conducted a Case Management visit in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA met with Elizabeth Zaragoza, Director who was informed of the reason for the visit.

Assembly Bill 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers constructed before January 1, 2010, to test their drinking and cooking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. LPA observed on the report provided by the SWRCB that Faucet G identified as having high levels of lead at 15 ppb.

The water fountain was located outside between the office and the admin office. The director, told LPA that the faucet was immediately turned off and placed out of service. LPA observed that the entire drinking fountain was removed and per Director water fountain was removed April 23, 2024.

Interview with Director revealed that the drinking fountain was not in use by staff or children for drinking or food preparation prior to removal. The children are provided bottled water for consumption when outdoors and when indoors children use the water fountain and faucets in the classroom for drinking.

See LIC 809D for cited deficiency in accordance with the California Code of Regulations Title 22, Division 12 written directives.

An exit interview was conducted with Elizabeth Zaragoza, Director. A copy of this report, appeal rights and a Notice of Site Visit was issued. Director reminded that the Notice of Site Visit must remain posted for 30 consecutive days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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 2
Document Has Been Signed on 04/25/2024 01:27 PM - It Cannot Be Edited


Created By: Cindy Hamilton On 04/25/2024 at 01:09 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 HEADSTART/STATE PRESCHOOL
FACILITY NUMBER: 330910496

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
101700.3(b)(1) California Lead Action Level at Child Care Centers
(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... (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:
1
2
3
4
5
6
7
The Director Elizabeth Zaragoza placed the water outlet out of service by removing the entire outdoor drinking fountain. The CCC is also providing bottled drinking water to children in care and utilizing faucets/drinking fountains located in classrooms. POC has been corrected
8
9
10
11
12
13
14
LPA Hamilton received water testing results taken on March 20, 2024 with an Action Level Exceedance of 15 which is higher than the allowable limit. The drinking fountain was located in outside between the office and admin office.
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:Carlos Martinez
LICENSING EVALUATOR NAME:Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2