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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490108941
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:18:49 AM

Document Has Been Signed on 02/14/2023 11:18 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SANTA ROSA JUNIOR COLLEGE/INFANT CENTERFACILITY NUMBER:
490108941
ADMINISTRATOR:ROSENBERG, TINAFACILITY TYPE:
830
ADDRESS:1501 MENDOCINO AVENUETELEPHONE:
(707) 527-4224
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 46TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Tina RosenbergTIME COMPLETED:
11:30 AM
NARRATIVE
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On 02/14/23, Licensing Program Analyst (LPA), Amy Strother made a case management inspection and met with Site Supervisor, Tina Rosenberg (D1). The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following water faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: sample site "EE" tested at 19 ppb and sample site “O” tested at 9 ppb. Please note that sample site "EE" is listed on both this facility license number and the preschool license #490109432 and will be addressed here under the infant license only. D1 stated that all faucets are sinks the teachers use in the classroom or work room. All other sources of water for this facility tested below the allowable level of 5.0 ppb.

LPA obtained the following documents from D1 via email on 12/20/22; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999). On 01/26/23 D1 emailed LPA a zip file containing photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999) as required and stated that all faucets with lead exceedances have been made inaccessible.

During today’s visit, LPA verified that the test results were posted and that faucets, “EE” and “O” have been made inaccessible to children in care. D1 stated that faucets were replaced early this morning, 02/14/23, will be in the process of being flushed and will be retested on 03/10/23. D1 stated that children in care are receiving drinking water both indoors and outdoors from reusable sippy cups refilled from sinks that meet the requirements.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor, Tina Rosenberg.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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Document Has Been Signed on 02/14/2023 11:18 AM - It Cannot Be Edited


Created By: Amy Strother On 02/14/2023 at 10:35 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SANTA ROSA JUNIOR COLLEGE/INFANT CENTER
FACILITY NUMBER: 490108941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.



This requirement was not met as evidenced by:
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LPA observed that the facility has temporarily removed the affected faucets “EE” and “O” from service by way of placing a bag over each sink faucet. D1 stated that the facility has replaced the faucets, will be flushing the faucets, with a plan to retest, submitting results to LPA at amy.strother@dss.ca.gov by 03/16/23.
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Based on record review, the facility had two faucets (site “EE” at 19 pbb and site “O” at 9 ppb) that exceeded the allowable levels of lead in the water. This is a potential health and safety risk to children in care.
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 D1 stated children in care are receiving drinking water from reusable sippy cups that are filled by sinks that meet the requirements and that families have been notified of the plans for remediation.

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Amy Strother
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023


LIC809 (FAS) - (06/04)
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