ADVENTURE CLUB - SARGENT ELM AFTER SCHOOL PROGRAM

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 01/24/2023, Licensing Program Analysts (LPAs) Jeremey McClain and Erwina Pascual-Golamco met with Licensing Representative Monique Mejorado for an unannounced Case Management Inspection. Upon arrival, LPAs observed 9 children supervised by two staff members. On 12/09/2022, a sample from a faucet/fountain combo located in the classroom was collected and tested for lead exceedance. Results indicated lead values 6.9 parts per billion (pbb), exceeding the recommended 5.5 pbb. The source was previously used for drinking, washing hands, and cooking. Usage of the water source was stopped immediately upon receiving the results, and the fountain and faucet has been made inaccessible. The facility will retest the source for lead exceedance once it has been replaced. Currently, children are bringing their own water bottles for drinking and there are other faucets that available for cooking and washing hands. Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected. An exit interview was conducted with the Licensing Representative. The facility has posted the report indicating the results. LPA provided licensing representative with Appeal Rights, and a Notice of Site Visit that must be posted for 30 days. SUPERVISORS NAME: Keven Peters LICENSING EVALUATOR NAME: Jeremey McClain LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023 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: ADVENTURE CLUB - SARGENT ELM AFTER SCHOOL PROGRAM FACILITY NUMBER: 310310244 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/24/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/24/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers. b) Testing results with fractional ppb readings of 0.5 or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. 1) A result with calues of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not 1 2 3 4 5 6 7Usage of the water source was stopped immediately and the faucet and fountain were taped off. Children use their own water bottles for drinking and there are other faucets on site for washing hands and drinking. The facility will test the source at a later date once repairs/replacements have been made. 8 9 10 11 12 13 14met as evidenced by lead results of a faucet/fountain combo indicating a result of 6.9 pbb on 12/09/22. This is a potential risk to the healtha and safety of children in care if not corrected. 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:Keven Peters LICENSING EVALUATOR NAME:Jeremey McClain LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023

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 01/24/2023, Licensing Program Analysts (LPAs) Jeremey McClain and Erwina Pascual-Golamco met with Licensing Representative Monique Mejorado for an unannounced Case Management Inspection. Upon arrival, LPAs observed 9 children supervised by two staff members. On 12/09/2022, a sample from a faucet/fountain combo located in the classroom was collected and tested for lead exceedance. Results indicated lead values 6.9 parts per billion (pbb), exceeding the recommended 5.5 pbb. The source was previously used for drinking, washing hands, and cooking. Usage of the water source was stopped immediately upon receiving the results, and the fountain and faucet has been made inaccessible. The facility will retest the source for lead exceedance once it has been replaced. Currently, children are bringing their own water bottles for drinking and there are other faucets that available for cooking and washing hands. Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected. An exit interview was conducted with the Licensing Representative. The facility has posted the report indicating the results. LPA provided licensing representative with Appeal Rights, and a Notice of Site Visit that must be posted for 30 days. SUPERVISORS NAME: Keven Peters LICENSING EVALUATOR NAME: Jeremey McClain LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023 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: ADVENTURE CLUB - SARGENT ELM AFTER SCHOOL PROGRAM FACILITY NUMBER: 310310244 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/24/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/24/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7California Lead Action Level at Child Care Centers. b) Testing results with fractional ppb readings of 0.5 or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. 1) A result with calues of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not 1 2 3 4 5 6 7Usage of the water source was stopped immediately and the faucet and fountain were taped off. Children use their own water bottles for drinking and there are other faucets on site for washing hands and drinking. The facility will test the source at a later date once repairs/replacements have been made. 8 9 10 11 12 13 14met as evidenced by lead results of a faucet/fountain combo indicating a result of 6.9 pbb on 12/09/22. This is a potential risk to the healtha and safety of children in care if not corrected. 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:Keven Peters LICENSING EVALUATOR NAME:Jeremey McClain LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023