HAGGINWOOD STATE PRESCHOOL

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 January 10, 2023, at approximately 8:30 AM Licensing Program Analyst (LPA) Alize Tillery met with Director Tanisha Symon to conduct an unannounced case management inspection. During today's inspection there were 5 preschool children, supervised by 2 staff. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in two outlets. A test result showing an amount of 5.5ppb, or over, is considered an Lead Action Level Exceedance. On 12/6/2022, the facility tested water samples for lead. Two water outlets sampled indicated an Action Level Exceedance (ALE). These outlets were marked L and J on the facility's sketch. Outlet L has an exceedance of 13ppb and outlet J with an exceedance of 9.2ppb. During today’s inspection, LPA did not have the sketch to determine which outlets were marked L and J. Director is not familiar with the sketch but will access it, to provide to LPA Tillery. Director stated that the cafeteria provides the children's meals and for drinking water they have filtered water jugs delivered. Director stated that she does not believe the preschool children have access to faucets L and J. A deficiency is cited on the following LIC809-D and a plan of correction was created with the Director, Tanisha Symon. A copy of this report and appeal rights were provided to the Director. SUPERVISORS NAME: Seychelle De Luca LICENSING EVALUATOR NAME: Alize Tillery 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 2 FACILITY NAME: HAGGINWOOD STATE PRESCHOOL FACILITY NUMBER: 340318296 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/31/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7(b)(1) A result with calues of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirment was not met, based on results received that showed water outlet L and J with a lead exceedance over 5.5ppb. 1 2 3 4 5 6 7Director will send to LPA Tillery the facility sketch with labeled outlets. LPA will return to clear the deficiency. 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 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:Seychelle De Luca LICENSING EVALUATOR NAME:Alize Tillery LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023

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 January 10, 2023, at approximately 8:30 AM Licensing Program Analyst (LPA) Alize Tillery met with Director Tanisha Symon to conduct an unannounced case management inspection. During today's inspection there were 5 preschool children, supervised by 2 staff. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in two outlets. A test result showing an amount of 5.5ppb, or over, is considered an Lead Action Level Exceedance. On 12/6/2022, the facility tested water samples for lead. Two water outlets sampled indicated an Action Level Exceedance (ALE). These outlets were marked L and J on the facility's sketch. Outlet L has an exceedance of 13ppb and outlet J with an exceedance of 9.2ppb. During today’s inspection, LPA did not have the sketch to determine which outlets were marked L and J. Director is not familiar with the sketch but will access it, to provide to LPA Tillery. Director stated that the cafeteria provides the children's meals and for drinking water they have filtered water jugs delivered. Director stated that she does not believe the preschool children have access to faucets L and J. A deficiency is cited on the following LIC809-D and a plan of correction was created with the Director, Tanisha Symon. A copy of this report and appeal rights were provided to the Director. SUPERVISORS NAME: Seychelle De Luca LICENSING EVALUATOR NAME: Alize Tillery 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 2 FACILITY NAME: HAGGINWOOD STATE PRESCHOOL FACILITY NUMBER: 340318296 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/31/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7(b)(1) A result with calues of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirment was not met, based on results received that showed water outlet L and J with a lead exceedance over 5.5ppb. 1 2 3 4 5 6 7Director will send to LPA Tillery the facility sketch with labeled outlets. LPA will return to clear the deficiency. 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 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:Seychelle De Luca LICENSING EVALUATOR NAME:Alize Tillery LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023