WILLOW CREEK ELEMENTARY SCHOOL DISTRICT 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 7/13/23 at 11:30am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with Linda Brandts. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet C drinking fountain in the preschool 5.9ppb The facility has made the faucet inaccessible by taping a bag over the the drinking fountain. Ms. Brandts stated the facility plans to replace the faucet and retest. The facility is currently closed for summer break. It is anticipated the faucet will be replaced by the time children return from summer break. If not, bottled water will be available for children and staff. The following deficiencies are 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 Ms. Brandts. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023 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 2 FACILITY NAME: WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL FACILITY NUMBER: 475408007 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/27/2023 Section Cited CCR 101700.3(b)2 1 2 3 4 5 6 7Licensees 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: Based 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. 1 2 3 4 5 6 7The licensee has made the faucets temporarily inaccessible by placing a bag over the faucet. The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling. Type B 07/14/2023 Section Cited HSC 1596.76 1 2 3 4 5 6 7(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.1 2 3 4 5 6 7Community Care Licensing received proof of testing. Citation cleared. 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:Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023

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 7/13/23 at 11:30am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with Linda Brandts. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet C drinking fountain in the preschool 5.9ppb The facility has made the faucet inaccessible by taping a bag over the the drinking fountain. Ms. Brandts stated the facility plans to replace the faucet and retest. The facility is currently closed for summer break. It is anticipated the faucet will be replaced by the time children return from summer break. If not, bottled water will be available for children and staff. The following deficiencies are 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 Ms. Brandts. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023 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 2 FACILITY NAME: WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL FACILITY NUMBER: 475408007 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/27/2023 Section Cited CCR 101700.3(b)2 1 2 3 4 5 6 7Licensees 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: Based 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. 1 2 3 4 5 6 7The licensee has made the faucets temporarily inaccessible by placing a bag over the faucet. The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling. Type B 07/14/2023 Section Cited HSC 1596.76 1 2 3 4 5 6 7(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.1 2 3 4 5 6 7Community Care Licensing received proof of testing. Citation cleared. 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:Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023

Type B citation - potential risk if not corrected

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 7/13/23 at 11:30am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with Linda Brandts. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet C drinking fountain in the preschool 5.9ppb The facility has made the faucet inaccessible by taping a bag over the the drinking fountain. Ms. Brandts stated the facility plans to replace the faucet and retest. The facility is currently closed for summer break. It is anticipated the faucet will be replaced by the time children return from summer break. If not, bottled water will be available for children and staff. The following deficiencies are 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 Ms. Brandts. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023 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 2 FACILITY NAME: WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL FACILITY NUMBER: 475408007 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/27/2023 Section Cited CCR 101700.3(b)2 1 2 3 4 5 6 7Licensees 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: Based 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. 1 2 3 4 5 6 7The licensee has made the faucets temporarily inaccessible by placing a bag over the faucet. The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling. Type B 07/14/2023 Section Cited HSC 1596.76 1 2 3 4 5 6 7(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.1 2 3 4 5 6 7Community Care Licensing received proof of testing. Citation cleared. 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:Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023

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 7/13/23 at 11:30am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with Linda Brandts. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water: Faucet C drinking fountain in the preschool 5.9ppb The facility has made the faucet inaccessible by taping a bag over the the drinking fountain. Ms. Brandts stated the facility plans to replace the faucet and retest. The facility is currently closed for summer break. It is anticipated the faucet will be replaced by the time children return from summer break. If not, bottled water will be available for children and staff. The following deficiencies are 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 Ms. Brandts. SUPERVISORS NAME: Erin Virrueta LICENSING EVALUATOR NAME: Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023 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 2 FACILITY NAME: WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL FACILITY NUMBER: 475408007 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 07/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 07/27/2023 Section Cited CCR 101700.3(b)2 1 2 3 4 5 6 7Licensees 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: Based 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. 1 2 3 4 5 6 7The licensee has made the faucets temporarily inaccessible by placing a bag over the faucet. The licensee plans to replace and retest the faucet. Retesting documents will be submitted within 2 weeks of the completed sampling. Type B 07/14/2023 Section Cited HSC 1596.76 1 2 3 4 5 6 7(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.1 2 3 4 5 6 7Community Care Licensing received proof of testing. Citation cleared. 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:Nicolette Cunningham LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023