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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216610
Report Date: 05/14/2024
Date Signed: 05/14/2024 05:12:38 PM

Document Has Been Signed on 05/14/2024 05:12 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PACIFIC CAMPS FAMILY RESOURCE,INC.FACILITY NUMBER:
566216610
ADMINISTRATOR/
DIRECTOR:		KENNETH HARLEYFACILITY TYPE:
860
ADDRESS:4050 MARKET STREETTELEPHONE:
(805) 654-0686
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 18DATE:
05/14/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Director Mcmillin Stacie,TIME VISIT/
INSPECTION COMPLETED:
05:25 PM
NARRATIVE
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On 05/14/2024, Licensing Program Analyst (LPA) German Negrete conducted an unannounced Case Management inspection at the above mentioned Child Care Center (CCC) to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by the CCC. LPA met with CCC Director, Mcmillin Stacie, and advised of the purpose of the inspection. LPA, in the company of Director, toured the interior and exterior of the CCC. LPA observed 18 children in care being supervised by 5 staff at the time of the inspection.

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 101704, which may include remediation.

The Regional Office received ALE reading for one water outlet in this facility. The CCC was notified of the reading (CCC Kitchen 9.0 Facucet) on 01/03/2024. In todays visit Director informed LPA the water fixtures have been removed from service. LPA advised Director, water fixtures should be covered by plastic to prevent children/staff from being able to consume water from the sources or wash food items consumed by children in care.

LPA advised the testing report must be posted and parents/authorized representative informed of the ALE. LPA notes the CCC has a testing prominently displayed near the entry of the CCC.

LPA provided a copy of PUB 515 and discussed the need for the CCC to share this with families, discussed a plan of correction with the Director and informed Director the Plan of Correction for lead exceedances must include notification of parents and information about what has been done and remediation plans for all water. CONTINUED ON LIC809-C
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PACIFIC CAMPS FAMILY RESOURCE,INC.
FACILITY NUMBER: 566216610
VISIT DATE: 05/14/2024
NARRATIVE
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outlets. LPA informed Director that parents must acknowledge receipt of Licensing report and POC.

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
· External Water Sampler Self-Certification Form (LIC 9275)
· Child Care Center Sampling Checklist Form (LIC 9276)
· CDSS Lead Toxicity Prevention and Water Testing Information page
· Resources listed on Sacramento State University, Office of Water Program website
· CCLD website: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

LPA advised Director that children must not have access to the outlet. Should the facility decide to use the outlet in the future for children in care, they must correct the ALE and retest to ensure they are staying in compliance.

Exit interview was conducted with Director.

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.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/14/2024 05:12 PM - It Cannot Be Edited


Created By: German Negrete On 05/14/2024 at 03:58 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: PACIFIC CAMPS FAMILY RESOURCE,INC.
FACILITY NUMBER: 566216610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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The CCC director will email Department of the signed LIC9224. Director will email images of the kitchen faucet being covered by a some type of plastic. Director will also provide an update on the status of the Kitchen faucet retesting date for lead contamination..
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Based on observation and interview, the Licensee did not comply with the section cited above as the Child Care Center did not have the facility's water sources tested for lead containment level until 12/15/2023 . This poses a potential health, safety or personal rights risk to persons 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:Ana Tolentino
LICENSING EVALUATOR NAME:German Negrete
LICENSING EVALUATOR SIGNATURE:
DATE: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024


LIC809 (FAS) - (06/04)
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