CII/WESTERN HEAD START 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 03/21/2024, about 2:15PM, Licensing Program Analysts (LPAs) T. Tran and A. Wallin conducted an unannounced case management/Lead inspection at CII Western Head Start. Upon arrival, LPAs met with Site Supervisor, Brenda Juarez and we toured the facility. LPAs observed proper care and supervision. The purpose of today's inspection was to go over the water lead test results received on 10/07/22. Results show that three water sources had action level exceedance of lead. The toddler and preschool's restroom sinks had lead exceedance result of at least 6.5 ppb and greater. Per facility representative, those three sources only use for children's hand washing. Children drinking water was provided by sparkling water delivered to the site weekly. The area with lead levels action were removed from service and rested on 4/12/23. A deficiency was cited to ensure that the water sources noted will not be used as a drinking source or food preparation source for the children. The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached. LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety. Record review indicated last retesting completed on 4/12/23. Citation was cleared during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Brenda Juarez. SUPERVISORS NAME: Denise Gibbs LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024 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: CII/WESTERN HEAD START STATE PRESCHOOL FACILITY NUMBER: 197418048 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/21/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/21/2024 Section Cited CCR 101700.3(b)(1)-(b) 1 2 3 4 5 6 7Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that three water sources had an action level exceedance. 1 2 3 4 5 6 7Facility had provided correction record completed on 4/12/23 all water outlet had been removed. Facility provide filtered water for the children to drink. POC cleared during today's visit. 8 9 10 11 12 13 14LPA observed all three outlets had been removed.This is a potential risk to the health and safety of the 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:Denise Gibbs LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024

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 03/21/2024, about 2:15PM, Licensing Program Analysts (LPAs) T. Tran and A. Wallin conducted an unannounced case management/Lead inspection at CII Western Head Start. Upon arrival, LPAs met with Site Supervisor, Brenda Juarez and we toured the facility. LPAs observed proper care and supervision. The purpose of today's inspection was to go over the water lead test results received on 10/07/22. Results show that three water sources had action level exceedance of lead. The toddler and preschool's restroom sinks had lead exceedance result of at least 6.5 ppb and greater. Per facility representative, those three sources only use for children's hand washing. Children drinking water was provided by sparkling water delivered to the site weekly. The area with lead levels action were removed from service and rested on 4/12/23. A deficiency was cited to ensure that the water sources noted will not be used as a drinking source or food preparation source for the children. The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached. LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety. Record review indicated last retesting completed on 4/12/23. Citation was cleared during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Brenda Juarez. SUPERVISORS NAME: Denise Gibbs LICENSING EVALUATOR NAME: Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024 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: CII/WESTERN HEAD START STATE PRESCHOOL FACILITY NUMBER: 197418048 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/21/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/21/2024 Section Cited CCR 101700.3(b)(1)-(b) 1 2 3 4 5 6 7Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that three water sources had an action level exceedance. 1 2 3 4 5 6 7Facility had provided correction record completed on 4/12/23 all water outlet had been removed. Facility provide filtered water for the children to drink. POC cleared during today's visit. 8 9 10 11 12 13 14LPA observed all three outlets had been removed.This is a potential risk to the health and safety of the 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:Denise Gibbs LICENSING EVALUATOR NAME:Tiffanie Tran LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024