KIRK O'THE VALLEY 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 02/27/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at Kirk O'The Valley Preschool to conduct an unannounced case management visit. LPA Ornelas was met by Administrative Director, Hillary Felder. LPA informed director about the purpose of the visit and was guided on a tour of the facility. LPA observed 43 children and 11 adults during today’s visit. The facility has been identified to have 1 water outlet with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility. On 02/17/2023, LPA Ornelas contacted Administrative Director Hillary Felder and informed Director of the testing results. LPA Ornelas obtained the following documents from director via email: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets). Director provided LPA with a copy of the results of lead water sample testing conducted on 01/21/2023. Per the report, the following water outlets yielded the following results: 1.) Sink/Faucet D (Inside Room 3): 29 ppb During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet that was bagged, taped, and labeled with the “Do Not Use” signage. LPA obtained photos of water outlet that was identified on the facility sketch. Director stated that the children do not consume water from the water outlet. Director further stated that there is a Culligan water dispenser along with a water filter dispenser located in the kitchen that is used to refill children's refillable water bottles throughout the day as needed. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023 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: KIRK O'THE VALLEY PRESCHOOL FACILITY NUMBER: 191201890 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/27/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/27/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7 California Lead Action Level at Child Care Centers. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:1 2 3 4 5 6 7 Faciilty has replaced faucets/ outlets, identified with an Action Lead Exceedance of 5.5 ppb or over. These outlets will not be accessible for use until a retest has occurred. Director will send LPA a copy of the re-test summary once completed on or before . 03/31/2023 8 9 10 11 12 13 14 Lead water testing samples taken on 01/21/2023 revealed that levels of lead were beyond the allowable amount deemed by the State of California. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons 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:Lisa Rios LICENSING EVALUATOR NAME:Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023 FACILITY NAME: KIRK O'THE VALLEY PRESCHOOLFACILITY NUMBER: 191201890 VISIT DATE: 02/27/2023 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 32Based on observation, interviews and supportive documents it has been determined that Kirk O'The Valley Preschool violated Child Care Licensing Regulation Division 12, Chapter 1, Subchapter 5 101700.3 (b)(1) California Lead Action Level at Child Care Centers. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. Lead water testing samples taken on 01/21/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during today’s visit 02/27/2023. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page. LPA discussed Proof of Correction (POC) with Administrative Director. Administrative Director demonstrated that all requir

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 02/27/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at Kirk O'The Valley Preschool to conduct an unannounced case management visit. LPA Ornelas was met by Administrative Director, Hillary Felder. LPA informed director about the purpose of the visit and was guided on a tour of the facility. LPA observed 43 children and 11 adults during today’s visit. The facility has been identified to have 1 water outlet with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility. On 02/17/2023, LPA Ornelas contacted Administrative Director Hillary Felder and informed Director of the testing results. LPA Ornelas obtained the following documents from director via email: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets). Director provided LPA with a copy of the results of lead water sample testing conducted on 01/21/2023. Per the report, the following water outlets yielded the following results: 1.) Sink/Faucet D (Inside Room 3): 29 ppb During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet that was bagged, taped, and labeled with the “Do Not Use” signage. LPA obtained photos of water outlet that was identified on the facility sketch. Director stated that the children do not consume water from the water outlet. Director further stated that there is a Culligan water dispenser along with a water filter dispenser located in the kitchen that is used to refill children's refillable water bottles throughout the day as needed. SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023 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: KIRK O'THE VALLEY PRESCHOOL FACILITY NUMBER: 191201890 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 02/27/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/27/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7 California Lead Action Level at Child Care Centers. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:1 2 3 4 5 6 7 Faciilty has replaced faucets/ outlets, identified with an Action Lead Exceedance of 5.5 ppb or over. These outlets will not be accessible for use until a retest has occurred. Director will send LPA a copy of the re-test summary once completed on or before . 03/31/2023 8 9 10 11 12 13 14 Lead water testing samples taken on 01/21/2023 revealed that levels of lead were beyond the allowable amount deemed by the State of California. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons 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:Lisa Rios LICENSING EVALUATOR NAME:Suzette Ornelas LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023 FACILITY NAME: KIRK O'THE VALLEY PRESCHOOLFACILITY NUMBER: 191201890 VISIT DATE: 02/27/2023 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 32Based on observation, interviews and supportive documents it has been determined that Kirk O'The Valley Preschool violated Child Care Licensing Regulation Division 12, Chapter 1, Subchapter 5 101700.3 (b)(1) California Lead Action Level at Child Care Centers. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. Lead water testing samples taken on 01/21/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during today’s visit 02/27/2023. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page. LPA discussed Proof of Correction (POC) with Administrative Director. Administrative Director demonstrated that all requir

Type B citation - potential risk if not corrected