SETA - DUDLEY HEAD START

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analysts (LPA) Fabiola Diaz and Karyn Guerra met with Facility Representative Carmen Osorio-Ruiz. for an unannounced Case Management Inspection. LPA observed there were currently 12 children in care with 3 staff. The purpose of today’s inspection was to follow up regarding water sampling that indicated Action Level Exceedance (ALE) for a faucet that was tested for lead levels on August 2022. Licensing was notified of the water levels that were in exceedance of 5 parts per billion in the faucet in the classroom which was used for drinking water. Carmen stated that the faucet was retested on 9/22/22, but Carmen has not received the test results LPAs observed a water dispenser in the classroom. Carmen stated that the facility has been using the water dispenser for drinking water, and they fill a water jug to take outside with disposable cups. Carmen explained that the faucet has now only been used for washing hands. LPAs informed the Facility Representative that Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP. See LIC809-D for Type B deficiency. LPA reviewed this report with the Facility Representative and conducted an exit interview. A Notice of Site Visit was provided and should remain posted for 30 days. SUPERVISORS NAME: Roxana Saravia LICENSING EVALUATOR NAME: Fabiola Diaz LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022 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 FACILITY NAME: SETA DUDLEY HEAD START FACILITY NUMBER: 343623991 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/29/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/01/2022 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:1 2 3 4 5 6 7LPAs observed a water dispenser in the classroom. Carmen stated that the facility has been using the water dispenser for drinking water, and they fill a water jug to take outside. 8 9 10 11 12 13 14Based on record review and interview, the faucet in the classroom exceeded the 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons in care. 8 9 10 11 12 13 14Carmen explained that the faucet has now only been used for washing hands. The faucet will not be used for water consumption, until it is no longer in lead levels exceedance. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Roxana Saravia LICENSING EVALUATOR NAME:Fabiola Diaz LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analysts (LPA) Fabiola Diaz and Karyn Guerra met with Facility Representative Carmen Osorio-Ruiz. for an unannounced Case Management Inspection. LPA observed there were currently 12 children in care with 3 staff. The purpose of today’s inspection was to follow up regarding water sampling that indicated Action Level Exceedance (ALE) for a faucet that was tested for lead levels on August 2022. Licensing was notified of the water levels that were in exceedance of 5 parts per billion in the faucet in the classroom which was used for drinking water. Carmen stated that the faucet was retested on 9/22/22, but Carmen has not received the test results LPAs observed a water dispenser in the classroom. Carmen stated that the facility has been using the water dispenser for drinking water, and they fill a water jug to take outside with disposable cups. Carmen explained that the faucet has now only been used for washing hands. LPAs informed the Facility Representative that Grant funding for testing and remediation is available referenced from Provider Information Notice (PIN) 21-04-CCP. See LIC809-D for Type B deficiency. LPA reviewed this report with the Facility Representative and conducted an exit interview. A Notice of Site Visit was provided and should remain posted for 30 days. SUPERVISORS NAME: Roxana Saravia LICENSING EVALUATOR NAME: Fabiola Diaz LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022 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 FACILITY NAME: SETA DUDLEY HEAD START FACILITY NUMBER: 343623991 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/29/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/01/2022 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:1 2 3 4 5 6 7LPAs observed a water dispenser in the classroom. Carmen stated that the facility has been using the water dispenser for drinking water, and they fill a water jug to take outside. 8 9 10 11 12 13 14Based on record review and interview, the faucet in the classroom exceeded the 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons in care. 8 9 10 11 12 13 14Carmen explained that the faucet has now only been used for washing hands. The faucet will not be used for water consumption, until it is no longer in lead levels exceedance. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Roxana Saravia LICENSING EVALUATOR NAME:Fabiola Diaz LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022

Type B citation - potential risk if not corrected