COLUSA PRESCHOOL LEARNING CENTER A

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 2/15/2023 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with CCOE Education Division Manager Donyale Miller. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet “A” – indoor sink with drinking fountain, 9.00 ppb The following deficiencies are being cited (see LIC 809D). 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. An exit interview was conducted, and the report was reviewed with CCOE Education Division Manager Donyale Miller . The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023 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: COLUSA HEAD START FACILITY NUMBER: 065403221 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/15/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/01/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: a record review, the facility has 1 1 2 3 4 5 6 7The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. 8 9 10 11 12 13 14indoor sink with drinking fountain with lead test results at or exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 Type B 03/01/2023 Section Cited CCR101703 1 2 3 4 5 6 7Post -Testing Requirements and Information This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. 1 2 3 4 5 6 7The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. The plan of correction shall be submitted to CCLD on or before 3/1/2023. 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:Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023

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 2/15/2023 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with CCOE Education Division Manager Donyale Miller. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet “A” – indoor sink with drinking fountain, 9.00 ppb The following deficiencies are being cited (see LIC 809D). 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. An exit interview was conducted, and the report was reviewed with CCOE Education Division Manager Donyale Miller . The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023 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: COLUSA HEAD START FACILITY NUMBER: 065403221 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/15/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/01/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: a record review, the facility has 1 1 2 3 4 5 6 7The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. 8 9 10 11 12 13 14indoor sink with drinking fountain with lead test results at or exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 Type B 03/01/2023 Section Cited CCR101703 1 2 3 4 5 6 7Post -Testing Requirements and Information This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. 1 2 3 4 5 6 7The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. The plan of correction shall be submitted to CCLD on or before 3/1/2023. 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:Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023

Type B citation - potential risk if not corrected

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 2/15/2023 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with CCOE Education Division Manager Donyale Miller. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet “A” – indoor sink with drinking fountain, 9.00 ppb The following deficiencies are being cited (see LIC 809D). 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. An exit interview was conducted, and the report was reviewed with CCOE Education Division Manager Donyale Miller . The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023 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: COLUSA HEAD START FACILITY NUMBER: 065403221 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/15/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/01/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: a record review, the facility has 1 1 2 3 4 5 6 7The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. 8 9 10 11 12 13 14indoor sink with drinking fountain with lead test results at or exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 Type B 03/01/2023 Section Cited CCR101703 1 2 3 4 5 6 7Post -Testing Requirements and Information This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. 1 2 3 4 5 6 7The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. The plan of correction shall be submitted to CCLD on or before 3/1/2023. 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:Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023

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 2/15/2023 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with CCOE Education Division Manager Donyale Miller. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet “A” – indoor sink with drinking fountain, 9.00 ppb The following deficiencies are being cited (see LIC 809D). 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. An exit interview was conducted, and the report was reviewed with CCOE Education Division Manager Donyale Miller . The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023 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: COLUSA HEAD START FACILITY NUMBER: 065403221 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/15/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/01/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: a record review, the facility has 1 1 2 3 4 5 6 7The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license. 8 9 10 11 12 13 14indoor sink with drinking fountain with lead test results at or exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 Type B 03/01/2023 Section Cited CCR101703 1 2 3 4 5 6 7Post -Testing Requirements and Information This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. 1 2 3 4 5 6 7The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form. The plan of correction shall be submitted to CCLD on or before 3/1/2023. 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:Laura Chavez LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023