CLAIRBOURN SCHOOL

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 01/20/2023, at 8:10 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with facility director, Karen Paciorek who guided LPA on a tour of the facility. Also present in the facility were 15 day care children and 4 staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility. Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA on 01/20/23. On 09/26/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 09/02/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows: SUPERVISORS NAME: Ana Chico LICENSING EVALUATOR NAME: Monique Jessica Ayala LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 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: CLAIRBOURN SCHOOLFACILITY NUMBER: 191500903 VISIT DATE: 01/20/2023 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 32C- Drinking Fountain (5.720 UG/L) - Not in use, water shut off E- Drinking Fountain (8.310 UG/L) - Not in use, water shut off G- Drinking Fountain (8.060 UG/L) - Not in use, water shut off I- Sink/Drinking Fountain Outside (29.900 UG/L) - Not in use, water shut off J- Sink/Drinking Fountain Outside (9.830 UG/L) - Not in use, water shut off K- Sink/Drinking Fountain Outside (12.400 UG/L) - Not in use, water shut off Director stated that the facility faucets have not been in use since COVID-19 pandemic, 2020. Facility had the water shut off since 2020 and turned the water back on for lead testing. The facility has shut the water leading to the above faucets off. Per director, an order for water filters has been placed and all faucets will be replaced and retested. Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information See LIC809D for Type B deficiency cited. An exit interview was conducted and a copy of this report was provided to director, Karen Paciorek along with Notice of Site Visit. A copy of PIN 21-21-CCP was provided along with Appeal Rights. SUPERVISORS NAME: Ana Chico LICENSING EVALUATOR NAME: Monique Jessica Ayala LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 FACILITY NAME: CLAIRBOURN SCHOOL FACILITY NUMBER: 191500903 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/20/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:1 2 3 4 5 6 7Director stated that the facuets have not been in use since 2020 and the water leading to these have were shut off. Director stated that the faucets have again been shut off once lead testing was complete. Director stated filters have been bought to place in the faucets and will retest the faucets. 8 9 10 11 12 13 14Based on record review, the licensee did not comply with the directive above, as six outlet (not in use) out of eighteen outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to 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

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 01/20/2023, at 8:10 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with facility director, Karen Paciorek who guided LPA on a tour of the facility. Also present in the facility were 15 day care children and 4 staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility. Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA on 01/20/23. On 09/26/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 09/02/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows: SUPERVISORS NAME: Ana Chico LICENSING EVALUATOR NAME: Monique Jessica Ayala LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 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: CLAIRBOURN SCHOOLFACILITY NUMBER: 191500903 VISIT DATE: 01/20/2023 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 32C- Drinking Fountain (5.720 UG/L) - Not in use, water shut off E- Drinking Fountain (8.310 UG/L) - Not in use, water shut off G- Drinking Fountain (8.060 UG/L) - Not in use, water shut off I- Sink/Drinking Fountain Outside (29.900 UG/L) - Not in use, water shut off J- Sink/Drinking Fountain Outside (9.830 UG/L) - Not in use, water shut off K- Sink/Drinking Fountain Outside (12.400 UG/L) - Not in use, water shut off Director stated that the facility faucets have not been in use since COVID-19 pandemic, 2020. Facility had the water shut off since 2020 and turned the water back on for lead testing. The facility has shut the water leading to the above faucets off. Per director, an order for water filters has been placed and all faucets will be replaced and retested. Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information See LIC809D for Type B deficiency cited. An exit interview was conducted and a copy of this report was provided to director, Karen Paciorek along with Notice of Site Visit. A copy of PIN 21-21-CCP was provided along with Appeal Rights. SUPERVISORS NAME: Ana Chico LICENSING EVALUATOR NAME: Monique Jessica Ayala LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 FACILITY NAME: CLAIRBOURN SCHOOL FACILITY NUMBER: 191500903 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/20/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:1 2 3 4 5 6 7Director stated that the facuets have not been in use since 2020 and the water leading to these have were shut off. Director stated that the faucets have again been shut off once lead testing was complete. Director stated filters have been bought to place in the faucets and will retest the faucets. 8 9 10 11 12 13 14Based on record review, the licensee did not comply with the directive above, as six outlet (not in use) out of eighteen outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to 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