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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701203
Report Date: 02/27/2023
Date Signed: 02/27/2023 10:02:41 AM

Document Has Been Signed on 02/27/2023 10:02 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENTFACILITY NUMBER:
376701203
ADMINISTRATOR:TANIA BELLOFACILITY TYPE:
850
ADDRESS:12979A COMMUNITY ROADTELEPHONE:
(858) 486-1284
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 40TOTAL ENROLLED CHILDREN: 15CENSUS: 14DATE:
02/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tania BelloTIME COMPLETED:
10:15 AM
NARRATIVE
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On 2/27/23 at 9:00am, LPA Patrick Ma made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Tania Bello. Also present in the facility were 14 daycare children and 4 teachers. Facility was within ratio & capacity. LPA examined the water outlets deemed an Action Level Exceedance.

Water outlets reported with 5.5 ppb or greater lead exceedance levels were as follows:

Kitchen sink A & A30 (one faucet) 37.0 ppb and 8.2 ppb

Director reported, outlet in exceedance was previously used for food preparation but since testing, have been replaced and are no longer being used for food prep until the faucet is retested and results indicate it is below lead exceedance level. All staff have been informed not to use the faucet for drinking water or food preparation and a sign has been posted by the outlet reminding all staff. Director reported they have been flushing the faucet 3 times per day and will schedule a retest for the new faucet after 3/28/23 (3 weeks after installing new faucet). Food for the children is brought in daily by a vendor and bottled water is used for food prep while filtered water is used for children drinking.

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Tania Bello. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
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 02/27/2023 10:02 AM - It Cannot Be Edited


Created By: Patrick Ma On 02/27/2023 at 09:52 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENT
FACILITY NUMBER: 376701203

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1) Written Directives per AB2370: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement is not met as evidenced by:
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Corrections were made prior to visit. Director stated, the kitchen faucet has been replaced and all staff have been informed not to use the faucets for drinking water or food preparation until retesting results indicate the faucet is below exceedance level. A sign has been posted by the sink not to use for food prep or drinking. Director stated she will reschedule a test after 3/28/23 to provide the recommended 3 weeks of flushing after replacing a faucet.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance level at one kitchen sink (but 2 results). This posed a potential health, safety or personal rights 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023


LIC809 (FAS) - (06/04)
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