HUMBOLDT COUNTY OFFICE OF EDUCATION - SPECIAL BEG

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 06/20/2024 at 9:00 AM, Licensing Program Analyst (LPA) Noah Wheeler made a case management inspection and met with Program Manager Kelly Love (PD). 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 ppb) of lead in the water: Staff Break Room, Faucet “A” – break room sink, 112.0 ppb The PD has made the faucet inaccessible by not using the faucet as it is in an adjacent non-licensed room that Facility staff was using to clean dishes and fill a water filtration system. The PD plans to cease use of the faucet in the Staff Break Room. Children in care are receiving drinking water from store bought bottled water. 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 Program Manager Kelly Love. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Noah Wheeler LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024 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: HUMBOLDT COUNTY OFFICE OF EDUCATION - SPECIAL BEG FACILITY NUMBER: 125408207 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 06/20/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 06/20/2024 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 licensee has made the faucet inaccessible by ceasing use of the faucet. The licensee agrees to permanently stop the use of the faucet in the Staff Break Room. 8 9 10 11 12 13 14Based on record review, the facility had one faucet with lead test results exceeding 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 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:Noah Wheeler LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024

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 06/20/2024 at 9:00 AM, Licensing Program Analyst (LPA) Noah Wheeler made a case management inspection and met with Program Manager Kelly Love (PD). 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 ppb) of lead in the water: Staff Break Room, Faucet “A” – break room sink, 112.0 ppb The PD has made the faucet inaccessible by not using the faucet as it is in an adjacent non-licensed room that Facility staff was using to clean dishes and fill a water filtration system. The PD plans to cease use of the faucet in the Staff Break Room. Children in care are receiving drinking water from store bought bottled water. 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 Program Manager Kelly Love. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Noah Wheeler LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024 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: HUMBOLDT COUNTY OFFICE OF EDUCATION - SPECIAL BEG FACILITY NUMBER: 125408207 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 06/20/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 06/20/2024 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 licensee has made the faucet inaccessible by ceasing use of the faucet. The licensee agrees to permanently stop the use of the faucet in the Staff Break Room. 8 9 10 11 12 13 14Based on record review, the facility had one faucet with lead test results exceeding 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 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:Noah Wheeler LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024