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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700014
Report Date: 06/06/2023
Date Signed: 06/06/2023 04:20:11 PM

Document Has Been Signed on 06/06/2023 04:20 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAPSLO - ATASCADERO HEAD STARTFACILITY NUMBER:
401700014
ADMINISTRATOR:KAREN EASTONFACILITY TYPE:
850
ADDRESS:965 EL CAMINO REALTELEPHONE:
(805) 466-2190
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 9DATE:
06/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karen EastonTIME COMPLETED:
04:35 PM
NARRATIVE
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On this date Licensing Program Analysts (LPAs) Dixie Wright and Elvin Baddley conducted an unannounced Case Management inspection to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by the Division of Drinking Water (DDW). LPAs met with Child Care Center Site Supervisor Karen Easton and explained the purpose of the inspection. There were nine day care children and three staff present.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) 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 (5) years after the date of the first test. If the water testing results indicate that the facility has an ALE, an immediate response shall be required pursuant to section 101700.3, which may include remediation.

The Regional Office received an ALE for one (1) water outlet in this facility. The faucet that tested high is in the kitchen of Building B. According to Site Supervisor, Building B has been closed since 2021 except for two weeks in March of 2023 when the building was temporarily used. According to Site Supervisor, the program has always provided purified water for drinking that is delivered to the Day Care; the children do not drink the faucet water.

During today’s inspection, LPAs toured building B and inspected the faucet in question. LPAs observed the faucet was taped up with a bag around it, with an "Out of Service, Do Not Use" sign on it.

Continued on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014
VISIT DATE: 06/06/2023
NARRATIVE
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LPAs advised that the testing report must be posted and parents/authorized representatives must be informed of the ALE.

LPA provided a copy of PUB 515 and discussed the need for the Center to share this with families.

LPA discussed a plan of correction with the Site Supervisor and informed Site Supervisor that the Plan of Correction must include notification of parents and information about what has been done (their current response, such as water fixture put out of use. CCC Plan of Actions to correct the deficiency are as follows:
  • Building is currently vacant and not in use
  • Faucet is taped off, and covered with a "Do Not Use" sign on it.
  • Plumber has done work and faucet is to be tested again and Site Supervisor will send the report to LPA D. Wright
  • Parents will be notified of the ALE

LPA shared the following resources quick references:
Quick references:
· PIN 22-06-CCP - Lead Testing in Child Care Centers – Frequently Asked Questions
· PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370

A type B deficiency is being cited today. Appeal rights were provided and explained. .
Exit interview conducted and report was reviewed with Karen Easton.
Notice of site visit provided and will be posted for 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/06/2023 04:20 PM - It Cannot Be Edited


Created By: Dixie Marie Wright On 06/06/2023 at 03:42 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2023
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater ... the Action Level. (1) A result with values of 5.5 ppb ... shall be deemed an Action Level Exceedance. This requirement was
not met as evidenced by CCC conducted
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The faucet has been taped up with a "Do Not Use" sign put on it. The Building is currently vacant and care is not being provided. According to Director, a plumber came out and did work to the area where the faucet had a lead exceedence. Facility is going to re-tes the faucet and will send the results to
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water lead testing and one water outlets exceeded the action level exceedance per regulations. This poses a potential risk to the health and safety of the children in care. Note: The faucet is in Building B, which is currently vacant.
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LPA Dixie Wright by 06/27/23 by email- dixie.wright@dss.ca.gov.

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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:Maria Mueller
LICENSING EVALUATOR NAME:Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


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