NCO HEAD START - PEARL CENTER

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 10/26/2023 at 8:45am, Licensing Program Analyst (LPA), Sebastian Phouthavong made a case management inspection and met with Site Supervisor, Jody Mederos. 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 parts per billion (ppb) of lead in the water: Simple Site “A” – playground drinking fountain, 13.000ppb and Simple Site "A30"- part of playground fountain, 5.200ppb. The staff have made the playground drinking fountain inaccessible by placing tight fitted bucket over it and posting a sign not to used. Children in care are receiving drinking water from water dispenser pitcher and individual cups. Site Supervisor stated the drinking fountain is being checked and in the process of receiving a retest. The facility has submitted the External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to CCL. 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 Site Supervisor, Jody Mederos. SUPERVISORS NAME: Leslie Lepori LICENSING EVALUATOR NAME: Sebastian Phouthavong LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023 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: NCO HEAD START - PEARL CENTER FACILITY NUMBER: 173000114 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/26/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/27/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7101700.3(b)(2) 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. This requirement was not met as evidenced by:1 2 3 4 5 6 7The facility has made drinking fountain temporarily inaccessible by covering it, and children receive drinking water fromwater dispenser pitcher and individual cups. Development Supervisor, Hyechong Froschl stated the water line and will retest again. 8 9 10 11 12 13 14The facility failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5 ppb or greater for the drinking fountain. Itis not deemed safe to drink. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14Retesting documents will be submitted within once completed to CCL by 11/27/2023. 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:Leslie Lepori LICENSING EVALUATOR NAME:Sebastian Phouthavong LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023

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 10/26/2023 at 8:45am, Licensing Program Analyst (LPA), Sebastian Phouthavong made a case management inspection and met with Site Supervisor, Jody Mederos. 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 parts per billion (ppb) of lead in the water: Simple Site “A” – playground drinking fountain, 13.000ppb and Simple Site "A30"- part of playground fountain, 5.200ppb. The staff have made the playground drinking fountain inaccessible by placing tight fitted bucket over it and posting a sign not to used. Children in care are receiving drinking water from water dispenser pitcher and individual cups. Site Supervisor stated the drinking fountain is being checked and in the process of receiving a retest. The facility has submitted the External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to CCL. 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 Site Supervisor, Jody Mederos. SUPERVISORS NAME: Leslie Lepori LICENSING EVALUATOR NAME: Sebastian Phouthavong LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023 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: NCO HEAD START - PEARL CENTER FACILITY NUMBER: 173000114 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/26/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/27/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7101700.3(b)(2) 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. This requirement was not met as evidenced by:1 2 3 4 5 6 7The facility has made drinking fountain temporarily inaccessible by covering it, and children receive drinking water fromwater dispenser pitcher and individual cups. Development Supervisor, Hyechong Froschl stated the water line and will retest again. 8 9 10 11 12 13 14The facility failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5 ppb or greater for the drinking fountain. Itis not deemed safe to drink. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14Retesting documents will be submitted within once completed to CCL by 11/27/2023. 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:Leslie Lepori LICENSING EVALUATOR NAME:Sebastian Phouthavong LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023

Type B citation - potential risk if not corrected