BCSD/ROOSEVELT ELEMENTARY PRE-KINDERGARTEN

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 1/12/23, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility. LPA met with State Preschool Program Coordinator (PC), Storiann Camps to discuss the results of the lead testing of the water at the facility. Based on information obtained from the water lead sampling test conducted by YES Environmental, Inc., it was determined there was an Action Level Exceedance (ALE), meaning there was a result with values of 5.5 ppb or greater. The ALE of 6.22 ppb was discovered in water source (B) and the ALE of 11.0 ppb was discovered in water source (D). Both water sources are located outside of the Pre-K classroom (#34) and were made inoperable upon the results of the lead exceedance. PC stated a correction action has already begun with the replacement of water source (B) and (D) and both water sources have been covered in plastic with an "out of service" sign placed on them. PC also stated the required flushing of the new water sources has already begun. PC said the water sources will not be used until the results of a second water lead sampling test have been received. PC stated preschool children have individual water bottles that are filled daily at the facility with purchased bottled water and are taken outside with them during outdoor activity. Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, 101700.3 (a) California's Action Level for lead in water at Child Care Centers is 5 ppb (b) Testing results with fractional ppb readings of 0.5 or greater shall be rounded up to the nearest whole number, before comparing to the Action Level (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required: The following deficiency was cited: (see next page titled 809-D) A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Storiann Camps. SUPERVISORS NAME: Luisa Gavoutian LICENSING EVALUATOR NAME: Kathy Pacheco LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023 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: BCSD/ROOSEVELT ELEMENTARY PRE-KINDERGARTEN FACILITY NUMBER: 153808412 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/12/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/17/2023 Section Cited 101700.3(c) 1 2 3 4 5 6 7(c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required. This requirement was not met as evidenced by results from the water lead sampling test showing an ALE1 2 3 4 5 6 7PC stated the facility will notify parents and/or authorized representatives of the lead exceedances and the corrective action that has already taken placed. PC also said a second water lead sampling test will be conducted, per Written Directives Section 101705 and all required documentation will be submitted 8 9 10 11 12 13 14of 6.22 ppb in water source (B) and 11.0 in water source (D). This poses a potential risk to the health, safey, and/or personal rights of children in care. 8 9 10 11 12 13 14to Community Care Licensing by 2/17/23. 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:Luisa Gavoutian LICENSING EVALUATOR NAME:Kathy Pacheco LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023

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 1/12/23, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced case management inspection at the facility. LPA met with State Preschool Program Coordinator (PC), Storiann Camps to discuss the results of the lead testing of the water at the facility. Based on information obtained from the water lead sampling test conducted by YES Environmental, Inc., it was determined there was an Action Level Exceedance (ALE), meaning there was a result with values of 5.5 ppb or greater. The ALE of 6.22 ppb was discovered in water source (B) and the ALE of 11.0 ppb was discovered in water source (D). Both water sources are located outside of the Pre-K classroom (#34) and were made inoperable upon the results of the lead exceedance. PC stated a correction action has already begun with the replacement of water source (B) and (D) and both water sources have been covered in plastic with an "out of service" sign placed on them. PC also stated the required flushing of the new water sources has already begun. PC said the water sources will not be used until the results of a second water lead sampling test have been received. PC stated preschool children have individual water bottles that are filled daily at the facility with purchased bottled water and are taken outside with them during outdoor activity. Per Title 22, Division 12, Chapter 1 of the California Code of Regulations, 101700.3 (a) California's Action Level for lead in water at Child Care Centers is 5 ppb (b) Testing results with fractional ppb readings of 0.5 or greater shall be rounded up to the nearest whole number, before comparing to the Action Level (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required: The following deficiency was cited: (see next page titled 809-D) A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Storiann Camps. SUPERVISORS NAME: Luisa Gavoutian LICENSING EVALUATOR NAME: Kathy Pacheco LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023 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: BCSD/ROOSEVELT ELEMENTARY PRE-KINDERGARTEN FACILITY NUMBER: 153808412 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/12/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/17/2023 Section Cited 101700.3(c) 1 2 3 4 5 6 7(c) If testing indicates an Action Level Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required. This requirement was not met as evidenced by results from the water lead sampling test showing an ALE1 2 3 4 5 6 7PC stated the facility will notify parents and/or authorized representatives of the lead exceedances and the corrective action that has already taken placed. PC also said a second water lead sampling test will be conducted, per Written Directives Section 101705 and all required documentation will be submitted 8 9 10 11 12 13 14of 6.22 ppb in water source (B) and 11.0 in water source (D). This poses a potential risk to the health, safey, and/or personal rights of children in care. 8 9 10 11 12 13 14to Community Care Licensing by 2/17/23. 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:Luisa Gavoutian LICENSING EVALUATOR NAME:Kathy Pacheco LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023