ASSOCIATED STUDENTS CHILDREN'S CENTER

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 7/20/22 at 1:53pm, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Jackie Hansen. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb) of lead in the water: Faucet “D” – indoor drinking fountain 11ppb The staff have made the faucet inaccessible by placing a black bag over it with a sign. Facility representative plans to retest the faucet and it is currently under flushing. Children in care did receive drinking water from water bottles and there are currently no children in care at the this time. The following deficiency is being cited (see LIC 809D). 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. Exit interview conducted and report was reviewed with the facility representative Jackie Hansen. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022 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: ASSOCIATED STUDENTS CHILDREN'S CENTER FACILITY NUMBER: 041370381 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/20/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/20/2022 Section Cited HSC 101238(a) 1 2 3 4 5 6 7The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: Based on record review, the facility had 1 faucet that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care. 1 2 3 4 5 6 7The facility representative agrees to submit an LIC 9275 and LIC 9276 by August 10th, 2022. The facility representative has replaced faucet and currently under flushing and testing.. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. OR 8 9 10 11 12 13 148 9 10 11 12 13 14The facility representative plans to retest faucet. Photos will be sent by 7/21/22 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:Megan Aviles LICENSING EVALUATOR NAME:Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022

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 7/20/22 at 1:53pm, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Jackie Hansen. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb) of lead in the water: Faucet “D” – indoor drinking fountain 11ppb The staff have made the faucet inaccessible by placing a black bag over it with a sign. Facility representative plans to retest the faucet and it is currently under flushing. Children in care did receive drinking water from water bottles and there are currently no children in care at the this time. The following deficiency is being cited (see LIC 809D). 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. Exit interview conducted and report was reviewed with the facility representative Jackie Hansen. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022 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: ASSOCIATED STUDENTS CHILDREN'S CENTER FACILITY NUMBER: 041370381 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/20/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/20/2022 Section Cited HSC 101238(a) 1 2 3 4 5 6 7The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: Based on record review, the facility had 1 faucet that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care. 1 2 3 4 5 6 7The facility representative agrees to submit an LIC 9275 and LIC 9276 by August 10th, 2022. The facility representative has replaced faucet and currently under flushing and testing.. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. OR 8 9 10 11 12 13 148 9 10 11 12 13 14The facility representative plans to retest faucet. Photos will be sent by 7/21/22 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:Megan Aviles LICENSING EVALUATOR NAME:Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 7/20/22 at 1:53pm, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Jackie Hansen. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb) of lead in the water: Faucet “D” – indoor drinking fountain 11ppb The staff have made the faucet inaccessible by placing a black bag over it with a sign. Facility representative plans to retest the faucet and it is currently under flushing. Children in care did receive drinking water from water bottles and there are currently no children in care at the this time. The following deficiency is being cited (see LIC 809D). 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. Exit interview conducted and report was reviewed with the facility representative Jackie Hansen. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022 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: ASSOCIATED STUDENTS CHILDREN'S CENTER FACILITY NUMBER: 041370381 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/20/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/20/2022 Section Cited HSC 101238(a) 1 2 3 4 5 6 7The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: Based on record review, the facility had 1 faucet that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care. 1 2 3 4 5 6 7The facility representative agrees to submit an LIC 9275 and LIC 9276 by August 10th, 2022. The facility representative has replaced faucet and currently under flushing and testing.. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. OR 8 9 10 11 12 13 148 9 10 11 12 13 14The facility representative plans to retest faucet. Photos will be sent by 7/21/22 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:Megan Aviles LICENSING EVALUATOR NAME:Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 7/20/22 at 1:53pm, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Jackie Hansen. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb) of lead in the water: Faucet “D” – indoor drinking fountain 11ppb The staff have made the faucet inaccessible by placing a black bag over it with a sign. Facility representative plans to retest the faucet and it is currently under flushing. Children in care did receive drinking water from water bottles and there are currently no children in care at the this time. The following deficiency is being cited (see LIC 809D). 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. Exit interview conducted and report was reviewed with the facility representative Jackie Hansen. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022 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: ASSOCIATED STUDENTS CHILDREN'S CENTER FACILITY NUMBER: 041370381 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/20/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/20/2022 Section Cited HSC 101238(a) 1 2 3 4 5 6 7The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: Based on record review, the facility had 1 faucet that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care. 1 2 3 4 5 6 7The facility representative agrees to submit an LIC 9275 and LIC 9276 by August 10th, 2022. The facility representative has replaced faucet and currently under flushing and testing.. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. OR 8 9 10 11 12 13 148 9 10 11 12 13 14The facility representative plans to retest faucet. Photos will be sent by 7/21/22 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:Megan Aviles LICENSING EVALUATOR NAME:Bianca Mendez LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022

Type B citation from complaint investigation - potential risk if not corrected