HEAD START - WORTHINGTON

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 May 27, 2022 at 8:30 am Licensing Program Analyst (LPA) Snow went to the administrative office for NORTHCOAST CHILDREN'S SERVICES located at 1266 9th street in Arcata to meet with Abraxas Layton. 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: H- (14 ppb) Kitchen faucet: replaced all the plumbing and it retested positive; it will remain shut off and singnage posted until it is cleared through additional testing. A & F- (6.1 ppb & 11 ppb) both drinking fountains one in each classroom, supply line & and shut off were replaced 2nd test both passed and are currently available for use. Children in care are receiving drinking water from pitchers & cups and the cleared drinking fountains. The kitchen is not using the H faucet. 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, Abraxas Layton. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Jaime Snow LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022 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: HEAD START - WORTHINGTON FACILITY NUMBER: 121373988 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/27/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 06/27/2022 Section Cited CCR 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: 1 2 3 4 5 6 7The licensee agrees to submit an LIC 9275 and LIC 9276 by 6/27/22. The licensee has made the faucets temporarily inaccessible by shutting them off. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. 8 9 10 11 12 13 14Based on record review, the facility had 3 faucets that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14Faucet: H in the kitchen needs retesting 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:Erin Virrueta LICENSING EVALUATOR NAME:Jaime Snow LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022

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 May 27, 2022 at 8:30 am Licensing Program Analyst (LPA) Snow went to the administrative office for NORTHCOAST CHILDREN'S SERVICES located at 1266 9th street in Arcata to meet with Abraxas Layton. 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: H- (14 ppb) Kitchen faucet: replaced all the plumbing and it retested positive; it will remain shut off and singnage posted until it is cleared through additional testing. A & F- (6.1 ppb & 11 ppb) both drinking fountains one in each classroom, supply line & and shut off were replaced 2nd test both passed and are currently available for use. Children in care are receiving drinking water from pitchers & cups and the cleared drinking fountains. The kitchen is not using the H faucet. 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, Abraxas Layton. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Jaime Snow LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022 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: HEAD START - WORTHINGTON FACILITY NUMBER: 121373988 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 05/27/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 06/27/2022 Section Cited CCR 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: 1 2 3 4 5 6 7The licensee agrees to submit an LIC 9275 and LIC 9276 by 6/27/22. The licensee has made the faucets temporarily inaccessible by shutting them off. The licensee plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. 8 9 10 11 12 13 14Based on record review, the facility had 3 faucets that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care.8 9 10 11 12 13 14Faucet: H in the kitchen needs retesting 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:Erin Virrueta LICENSING EVALUATOR NAME:Jaime Snow LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022

Type B citation - potential risk if not corrected