SBCUSD-CYPRESS ELEMENTARY

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Due to required lead testing requirements, Licensing Program Analyst (LPA), Justin Giese conducted a Case Management inspection based on lead testing results received from the facility. LPA toured the facility, took census and met with Permit Teacher, Mary Carmen Landa to further discuss lead testing results received and measures taken for remediation of lead exceedances. The Facility conducted initial water/lead testing on drinking fountain outlets on 01/19/2023. Outlet C, which was identified as a drinking fountain bubbler located on the exterior of the facility building, tested with a result of 7.4ppb. LPA was informed by the Permit Teacher, the outlet was placed out of service and signs posted for cessation of use. The facility employed remediation efforts and conducted a subsequent test on Outlet C on 10/03/2023, which yielded a satisfactory result of 1.8ppb. LPA observed outlet C to be functioning and in service during todays inspection. Although facility took immediate action to remedy outlet C's exceedance, due to water outlet C's initial testing on 1/19/2023 with a lead exceedance above approved lead levels, a deficiency has been cited. See LIC809D for Type B Deficiency. This deficiency will be cited and cleared as part of todays inspection. An exit interview was conducted, and appeal rights were provided/discussed. LPA provided Permit Teacher, Mary Carmen Landa with a copy of this report and notice of site visit, which must be posted for the next 30 days. SUPERVISORS NAME: Gilbert Sena LICENSING EVALUATOR NAME: Justin Giese LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024 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: SBCUSD-CYPRESS ELEMENTARY FACILITY NUMBER: 364807114 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/08/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/08/2024 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers 101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This is evidenced by:1 2 3 4 5 6 7Although facility took action to remedy outlet C's exceedance, due to water outlet C's initial testing on 1/19/2023 with a lead exceedance above approved lead levels, a deficiency has been cited. The facility employed remediation efforts and conducted a subsequent test on Outlet C on 10/03/2023 which yielded 8 9 10 11 12 13 14Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlet C (7.4ppb) This is a potential health and safety risk to persons in care.8 9 10 11 12 13 14a satisfactory result of 1.8ppb. LPA observed outlet C to be functioning and in service during todays inspection. This deficiency will be cited and cleared as part of todays inspection. 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:Gilbert Sena LICENSING EVALUATOR NAME:Justin Giese LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Due to required lead testing requirements, Licensing Program Analyst (LPA), Justin Giese conducted a Case Management inspection based on lead testing results received from the facility. LPA toured the facility, took census and met with Permit Teacher, Mary Carmen Landa to further discuss lead testing results received and measures taken for remediation of lead exceedances. The Facility conducted initial water/lead testing on drinking fountain outlets on 01/19/2023. Outlet C, which was identified as a drinking fountain bubbler located on the exterior of the facility building, tested with a result of 7.4ppb. LPA was informed by the Permit Teacher, the outlet was placed out of service and signs posted for cessation of use. The facility employed remediation efforts and conducted a subsequent test on Outlet C on 10/03/2023, which yielded a satisfactory result of 1.8ppb. LPA observed outlet C to be functioning and in service during todays inspection. Although facility took immediate action to remedy outlet C's exceedance, due to water outlet C's initial testing on 1/19/2023 with a lead exceedance above approved lead levels, a deficiency has been cited. See LIC809D for Type B Deficiency. This deficiency will be cited and cleared as part of todays inspection. An exit interview was conducted, and appeal rights were provided/discussed. LPA provided Permit Teacher, Mary Carmen Landa with a copy of this report and notice of site visit, which must be posted for the next 30 days. SUPERVISORS NAME: Gilbert Sena LICENSING EVALUATOR NAME: Justin Giese LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024 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: SBCUSD-CYPRESS ELEMENTARY FACILITY NUMBER: 364807114 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/08/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/08/2024 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers 101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This is evidenced by:1 2 3 4 5 6 7Although facility took action to remedy outlet C's exceedance, due to water outlet C's initial testing on 1/19/2023 with a lead exceedance above approved lead levels, a deficiency has been cited. The facility employed remediation efforts and conducted a subsequent test on Outlet C on 10/03/2023 which yielded 8 9 10 11 12 13 14Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlet C (7.4ppb) This is a potential health and safety risk to persons in care.8 9 10 11 12 13 14a satisfactory result of 1.8ppb. LPA observed outlet C to be functioning and in service during todays inspection. This deficiency will be cited and cleared as part of todays inspection. 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:Gilbert Sena LICENSING EVALUATOR NAME:Justin Giese LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024

Type B citation - potential risk if not corrected