CARVER HEAD START/STATE PRESCHOOL

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 04/12/2024, about 9:00AM, Licensing Program Analysts (LPAs) T. Tran and P. Bowden conduct an unannounced case management for Lead at the above licensed facility. Upon arrival, LPA met with Lead Teacher, Jacqueline Ruvalcaba and we toured the facility. LPAs observed proper care and supervision. The purpose of today's inspection was to go over the water lead test results received on 10/11/22. Results show that a water sources had action level exceedance of lead. The water fountain located on the hallway between the two classrooms had a lead result of 11. LPA observed the water bubbler was covered and disconnected. Per facility representative, facility provided sparkling water with paper cups for children to drink. A deficiency was cited to ensure that the water source noted would not be used as a drinking source or food preparation source for the children. The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety. Plan of correction was cleared during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Jacqueline Ruvalcaba. SUPERVISORS NAME: Denise Gibbs LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024 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 2 FACILITY NAME: CARVER HEAD START/STATE PRESCHOOL FACILITY NUMBER: 191597736 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/12/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/12/2024 Section Cited CCR 101700.3(b)(1)-(b) 1 2 3 4 5 6 7Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that a water sources had an action level exceedance. 1 2 3 4 5 6 7Facility had provided correction record completed on 320/23 water outlet had been corrected. Facility provide filtered water for the children to drink. POC cleared during today's visit. 8 9 10 11 12 13 14LPA observed the water bubbler had been covered and made inaccessible to children in care.This is a potential risk to the health and safety of the 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:Denise Gibbs LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024

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 04/12/2024, about 9:00AM, Licensing Program Analysts (LPAs) T. Tran and P. Bowden conduct an unannounced case management for Lead at the above licensed facility. Upon arrival, LPA met with Lead Teacher, Jacqueline Ruvalcaba and we toured the facility. LPAs observed proper care and supervision. The purpose of today's inspection was to go over the water lead test results received on 10/11/22. Results show that a water sources had action level exceedance of lead. The water fountain located on the hallway between the two classrooms had a lead result of 11. LPA observed the water bubbler was covered and disconnected. Per facility representative, facility provided sparkling water with paper cups for children to drink. A deficiency was cited to ensure that the water source noted would not be used as a drinking source or food preparation source for the children. The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety. Plan of correction was cleared during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Jacqueline Ruvalcaba. SUPERVISORS NAME: Denise Gibbs LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024 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 2 FACILITY NAME: CARVER HEAD START/STATE PRESCHOOL FACILITY NUMBER: 191597736 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/12/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/12/2024 Section Cited CCR 101700.3(b)(1)-(b) 1 2 3 4 5 6 7Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that a water sources had an action level exceedance. 1 2 3 4 5 6 7Facility had provided correction record completed on 320/23 water outlet had been corrected. Facility provide filtered water for the children to drink. POC cleared during today's visit. 8 9 10 11 12 13 14LPA observed the water bubbler had been covered and made inaccessible to children in care.This is a potential risk to the health and safety of the 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:Denise Gibbs LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024