LAYTONVILLE 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 01/10/23, Licensing Program Analyst (LPA), Amy Strother conducted a case management tele-inspection with Director, Misty Frost (D1). Due to severe winter storms with high wind and flooding the Department has approved a virtual inspection. D1 agreed to conduct the visit using FaceTime with LPA for the Tele-Inspection. 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 water faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "B" a sink faucet in room #12 with a reading of 8.7 ppb, Sample Site “C” a drinking fountain in room #12 had a reading of 55 ppb and Sample Site “D” a drinking fountain in room #11 had a reading of 39 ppb. All other sources of water tested (Sample Site “A”) below the allowable level of 5.0 ppb. LPA Strother received an email from Kristin Hills (A1), Director of Early Learning and Care, Educational Services for Mendocino County Office of Education on 01/03/22 stating that the facility has discontinued use of faucets “B”, “C” and “D” and have begun to notify families of the testing results. LPA obtained the following documents from A1 via email on 01/03/22; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999), a copy of the lab report, and a copy of the letter given to parents or authorized representatives of children in care, dated 01/03/22 and photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999). On 01/04/22 LPA Strother emailed a copy of the lead report from the California State Water Resource Control Board to A1. During today’s tele-visit, LPA verified that the test results were posted and that Sample sites “B”, “C” and “D” were made inaccessible to children in care by way of plastic bag covers with sign stating "Do Not Use". D1 stated that children in care are receiving drinking water from individual water bottles from home that staff can refill from store bought bottled water provided by the school district. D1 stated if a child forgets their water bottles a disposable cup with the bottled water is provided. Continue on LIC809-C SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023 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 3 FACILITY NAME: LAYTONVILLE STATE PRESCHOOLFACILITY NUMBER: 233004397 VISIT DATE: 01/10/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32The following deficiency is being cited (see LIC 809D). Appeal Rights were provided via email. A notice of site visit was given via email 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 Director, Misty Frost . D1’s signature was not recorded on this LIC809, LIC809-C or LIC809-D; however, D1 was provided with a copy of the LIC809, LIC809-C and LIC809-D; and D1’s confirmation of read receipt is on file. The report was also emailed to A1. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023 FACILITY NAME: LAYTONVILLE STATE PRESCHOOL FACILITY NUMBER: 233004397 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/10/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: 1 2 3 4 5 6 7LPA observed that the facility has temporarily removed the affected faucets “B”, “C” and “D” from service by way of a sign and plastic cover. D1 stated that the facility plans to replace sink faucet "B", flush it and retest, submitting results to amy.strother@dss.ca.gov by 02/10/23. D1 stated that drinking faucets "C" and "D" will be capped off and will submit photos of the completed work as documentation. 8 9 10 11 12 13 14Based on record review, the facility had three faucets (Site “B”, “C” and “D”) that exceeded that allowable levels of lead in the water (8.7, 55, and 39 ppb). This is a potential hea

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 01/10/23, Licensing Program Analyst (LPA), Amy Strother conducted a case management tele-inspection with Director, Misty Frost (D1). Due to severe winter storms with high wind and flooding the Department has approved a virtual inspection. D1 agreed to conduct the visit using FaceTime with LPA for the Tele-Inspection. 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 water faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "B" a sink faucet in room #12 with a reading of 8.7 ppb, Sample Site “C” a drinking fountain in room #12 had a reading of 55 ppb and Sample Site “D” a drinking fountain in room #11 had a reading of 39 ppb. All other sources of water tested (Sample Site “A”) below the allowable level of 5.0 ppb. LPA Strother received an email from Kristin Hills (A1), Director of Early Learning and Care, Educational Services for Mendocino County Office of Education on 01/03/22 stating that the facility has discontinued use of faucets “B”, “C” and “D” and have begun to notify families of the testing results. LPA obtained the following documents from A1 via email on 01/03/22; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999), a copy of the lab report, and a copy of the letter given to parents or authorized representatives of children in care, dated 01/03/22 and photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999). On 01/04/22 LPA Strother emailed a copy of the lead report from the California State Water Resource Control Board to A1. During today’s tele-visit, LPA verified that the test results were posted and that Sample sites “B”, “C” and “D” were made inaccessible to children in care by way of plastic bag covers with sign stating "Do Not Use". D1 stated that children in care are receiving drinking water from individual water bottles from home that staff can refill from store bought bottled water provided by the school district. D1 stated if a child forgets their water bottles a disposable cup with the bottled water is provided. Continue on LIC809-C SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023 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 3 FACILITY NAME: LAYTONVILLE STATE PRESCHOOLFACILITY NUMBER: 233004397 VISIT DATE: 01/10/2023 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32The following deficiency is being cited (see LIC 809D). Appeal Rights were provided via email. A notice of site visit was given via email 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 Director, Misty Frost . D1’s signature was not recorded on this LIC809, LIC809-C or LIC809-D; however, D1 was provided with a copy of the LIC809, LIC809-C and LIC809-D; and D1’s confirmation of read receipt is on file. The report was also emailed to A1. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023 FACILITY NAME: LAYTONVILLE STATE PRESCHOOL FACILITY NUMBER: 233004397 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/10/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: 1 2 3 4 5 6 7LPA observed that the facility has temporarily removed the affected faucets “B”, “C” and “D” from service by way of a sign and plastic cover. D1 stated that the facility plans to replace sink faucet "B", flush it and retest, submitting results to amy.strother@dss.ca.gov by 02/10/23. D1 stated that drinking faucets "C" and "D" will be capped off and will submit photos of the completed work as documentation. 8 9 10 11 12 13 14Based on record review, the facility had three faucets (Site “B”, “C” and “D”) that exceeded that allowable levels of lead in the water (8.7, 55, and 39 ppb). This is a potential hea

Type B citation - potential risk if not corrected