AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 02/23/2024, at 12:30PM, Licensing Program Analyst (LPAs)Mary Silva and Saul Valenzuela conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA(s) met with principal Dr. Donna Martyn and Juan Ruelas Intervention Success Coach, whom reason for visit was explained. LPA(s) were taken on a tour of facility. No children or staff were present during the inspection. There are 25 children currently enrolled. This is a preschool program with one session from 8:00am-11:00am. LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to Licensing staff on 01/28/24. On 11/01/2023, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 10/25/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows: A – Sink/Drinking Faucet in Room 20 (27.400 UG/L) – Faucet currently not in use A30 – Sink/Drinking Faucet in Room 20 (31.600 UG/L) – Faucet currently not in use B – Sink Faucet in Room 20 (28.500 UG/L) – Faucet currently not in use Principal stated that the facility was using faucet next to the bathrooms labeled A and A30 for hand washing and drinking. The water outlet labeled B located in the north end of classroom (teacher work room) are not being used for drinking. The teacher work room is used to prepare art and craft activities. Children do not have access to the teacher’s work room. When the facility was informed it was exceeding acceptable levels of lead the facility covered water outlets with plastic bags making it inaccessible to children and staff. Facility provides water bottles for drinking and are utilizing the restroom across the quad for hand washing. ________________________________Page 1___________________________________________ SUPERVISORS NAME: Christina Gabelman LICENSING EVALUATOR NAME: Mary Silva LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024 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 3 FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTONFACILITY NUMBER: 198020493 VISIT DATE: 02/23/2024 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. 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. An exit interview was conducted, a copy of the report, PIN 21-21-CCP and appeal rights was provided to Principal Dr. Donna Martyn. ________________________________________Page 2_____________________________________ SUPERVISORS NAME: Christina Gabelman LICENSING EVALUATOR NAME: Mary Silva LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024 FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON FACILITY NUMBER: 198020493 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/25/2024 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 02/23/2024, at 12:30PM, Licensing Program Analyst (LPAs)Mary Silva and Saul Valenzuela conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA(s) met with principal Dr. Donna Martyn and Juan Ruelas Intervention Success Coach, whom reason for visit was explained. LPA(s) were taken on a tour of facility. No children or staff were present during the inspection. There are 25 children currently enrolled. This is a preschool program with one session from 8:00am-11:00am. LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to Licensing staff on 01/28/24. On 11/01/2023, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 10/25/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows: A – Sink/Drinking Faucet in Room 20 (27.400 UG/L) – Faucet currently not in use A30 – Sink/Drinking Faucet in Room 20 (31.600 UG/L) – Faucet currently not in use B – Sink Faucet in Room 20 (28.500 UG/L) – Faucet currently not in use Principal stated that the facility was using faucet next to the bathrooms labeled A and A30 for hand washing and drinking. The water outlet labeled B located in the north end of classroom (teacher work room) are not being used for drinking. The teacher work room is used to prepare art and craft activities. Children do not have access to the teacher’s work room. When the facility was informed it was exceeding acceptable levels of lead the facility covered water outlets with plastic bags making it inaccessible to children and staff. Facility provides water bottles for drinking and are utilizing the restroom across the quad for hand washing. ________________________________Page 1___________________________________________ SUPERVISORS NAME: Christina Gabelman LICENSING EVALUATOR NAME: Mary Silva LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024 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 3 FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTONFACILITY NUMBER: 198020493 VISIT DATE: 02/23/2024 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. 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. An exit interview was conducted, a copy of the report, PIN 21-21-CCP and appeal rights was provided to Principal Dr. Donna Martyn. ________________________________________Page 2_____________________________________ SUPERVISORS NAME: Christina Gabelman LICENSING EVALUATOR NAME: Mary Silva LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024 FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON FACILITY NUMBER: 198020493 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/23/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/25/2024 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5