GREENVILLE STATE PRESCHOOL

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 8/31/22, at 12 pm, Licensing Program Analyst (LPA) Wisehart made a case management inspection and met with Site Manager, Gina Woods. 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 “A” – Sink Faucet, w/fountain Classroom #1, 5.9 ppb The faucet is used for hand washing only and a sign has been placed near the sink notifying users that it’s not drinkable water. The licensee replaced the faucet and is retesting on Tue 9/6/22. Children in care are receiving drinking water from water jug/cups and the jugs are filled up off site. 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 Manager, Gina Woods.. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022 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: GREENVILLE STATE PRESCHOOL FACILITY NUMBER: 325406650 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/31/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 08/31/2022 Section Cited CCR 101238(a) 1 2 3 4 5 6 7Buildings and Grounds 101238(a) The 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 9/14. The licensee posted a sign above the hand washing faucet. The faucet has been taken offline. Retesting documents will be submitted within 2 weeks of the completed sampling or by 9/14. 8 9 10 11 12 13 14Based 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.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:Megan Aviles LICENSING EVALUATOR NAME:Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022

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 8/31/22, at 12 pm, Licensing Program Analyst (LPA) Wisehart made a case management inspection and met with Site Manager, Gina Woods. 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 “A” – Sink Faucet, w/fountain Classroom #1, 5.9 ppb The faucet is used for hand washing only and a sign has been placed near the sink notifying users that it’s not drinkable water. The licensee replaced the faucet and is retesting on Tue 9/6/22. Children in care are receiving drinking water from water jug/cups and the jugs are filled up off site. 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 Manager, Gina Woods.. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022 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: GREENVILLE STATE PRESCHOOL FACILITY NUMBER: 325406650 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/31/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Request Denied Type B 08/31/2022 Section Cited CCR 101238(a) 1 2 3 4 5 6 7Buildings and Grounds 101238(a) The 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 9/14. The licensee posted a sign above the hand washing faucet. The faucet has been taken offline. Retesting documents will be submitted within 2 weeks of the completed sampling or by 9/14. 8 9 10 11 12 13 14Based 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.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:Megan Aviles LICENSING EVALUATOR NAME:Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022

Type B citation - potential risk if not corrected