ALA COSTA CTR. FOR THE DEVELOPMENTALLY DISABLED

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 25Licensing Program Analyst (LPA) Diana Campos conducted an unannounced case management inspection in regards to three faucets at the facility having lead exceedance. Facility had the water tested 12/03/22. It was found that two faucets in the boys bathroom, identified as faucets 2 and 3, and one faucet in the girls bathroom identified as faucet 7 had lead that exceeded the acceptable amount of lead allowed in a child care center. The faucets identified have not been used for cooking or drinking water. Children bring their food from home and the facility provides a snack. The faucet used for cooking water (faucet 8H) did not test with lead exceedance. The faucets that had lead exceedance have not been replaced yet. The facility will have the faucets repaired and water retested. Director agrees to notify LPA of the repair and retest date and send LPA the results of the testing. Notice of Site Visit was provided and must be posted for 30 days. Exit interview conducted and report reviewed with Executive Director Michael Pereira. SUPERVISORS NAME: Sherelle Johnson LICENSING EVALUATOR NAME: Diana Campos LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023 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: ALA COSTA CTR. FOR THE DEVELOPMENTALLY DISABLED FACILITY NUMBER: 010210187 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/30/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/29/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7100700.3 (b)(2) that states “Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.1 2 3 4 5 6 7Facility shall submit by the POC date a plan of action on when and how the faucets will be repaired to correct the lead exceedance and subsequently retested for lead values. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Licensee failed to maintain a lead value at or below the Action Level for water lead testing. This poses a potential risk to the health and safety of children in care.8 9 10 11 12 13 14 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:Sherelle Johnson LICENSING EVALUATOR NAME:Diana Campos LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Diana Campos conducted an unannounced case management inspection in regards to three faucets at the facility having lead exceedance. Facility had the water tested 12/03/22. It was found that two faucets in the boys bathroom, identified as faucets 2 and 3, and one faucet in the girls bathroom identified as faucet 7 had lead that exceeded the acceptable amount of lead allowed in a child care center. The faucets identified have not been used for cooking or drinking water. Children bring their food from home and the facility provides a snack. The faucet used for cooking water (faucet 8H) did not test with lead exceedance. The faucets that had lead exceedance have not been replaced yet. The facility will have the faucets repaired and water retested. Director agrees to notify LPA of the repair and retest date and send LPA the results of the testing. Notice of Site Visit was provided and must be posted for 30 days. Exit interview conducted and report reviewed with Executive Director Michael Pereira. SUPERVISORS NAME: Sherelle Johnson LICENSING EVALUATOR NAME: Diana Campos LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023 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: ALA COSTA CTR. FOR THE DEVELOPMENTALLY DISABLED FACILITY NUMBER: 010210187 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/30/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/29/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7100700.3 (b)(2) that states “Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.1 2 3 4 5 6 7Facility shall submit by the POC date a plan of action on when and how the faucets will be repaired to correct the lead exceedance and subsequently retested for lead values. 8 9 10 11 12 13 14This requirement was not met as evidenced by: Licensee failed to maintain a lead value at or below the Action Level for water lead testing. This poses a potential risk to the health and safety of children in care.8 9 10 11 12 13 14 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:Sherelle Johnson LICENSING EVALUATOR NAME:Diana Campos LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023