KIDANGO FOXDALE

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected

This exceedance levels found in “I” bubbler and sink was 11 ppb. This poses a potential risk to the Health, Safety, or Personal Rights of children in care.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA), Harsimran Kaur, conducted an unannounced case management inspection in response to a completed lead testing. which resulted in one action level exceedances within the facility of 11 ppb. LPA met with the Director, and explained Thao Nguyen the nature of today's inspection. Prior to today’s inspection, Community Care Licensing received notification of the lead exceedances by the water program. Preceding the arrival of Kaur, the fountain that have been found in exceedance have been taped off and are not being used. The water sample conducted by Alpha laboraties on 10/14//22, indicated the following: 1) Water bubbler and sink named "I" located in restroom has Lead Action Level Exceedance value of 11 ppb. LPA has the obtained documents during today’s inspection Director. 1.Self-Certification (LIC9275) 2.Sampling Checklist Form (LIC9276) 3.Facility Sketch LIC 999 (fully labeled with locations of all water outlets) 4. Full lead report from water program Type B deficiency was cited, exit interview conducted, and a copy of this report was given and reviewed with the Facility Representative, Thao Nguyen. Appeal rights were reviewed and provided. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS. SUPERVISORS NAME: Diana Stephenson LICENSING EVALUATOR NAME: Harsimran Kaur LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023 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: KIDANGO FOXDALE FACILITY NUMBER: 434415705 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/07/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/14/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Lead Testing Written Directives section 101700.3 (b)(1), a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:1 2 3 4 5 6 7Director, Thao Nguyen stated that they will remediate the exceedances and contact Alpha to retest. Director stated she will send documentation of remidation as well as retesting. 8 9 10 11 12 13 14This exceedance levels found in “I” bubbler and sink was 11 ppb. This poses a potential risk to the Health, Safety, or Personal Rights of 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 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:Diana Stephenson LICENSING EVALUATOR NAME:Harsimran Kaur LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023

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 25Licensing Program Analyst (LPA), Harsimran Kaur, conducted an unannounced case management inspection in response to a completed lead testing. which resulted in one action level exceedances within the facility of 11 ppb. LPA met with the Director, and explained Thao Nguyen the nature of today's inspection. Prior to today’s inspection, Community Care Licensing received notification of the lead exceedances by the water program. Preceding the arrival of Kaur, the fountain that have been found in exceedance have been taped off and are not being used. The water sample conducted by Alpha laboraties on 10/14//22, indicated the following: 1) Water bubbler and sink named "I" located in restroom has Lead Action Level Exceedance value of 11 ppb. LPA has the obtained documents during today’s inspection Director. 1.Self-Certification (LIC9275) 2.Sampling Checklist Form (LIC9276) 3.Facility Sketch LIC 999 (fully labeled with locations of all water outlets) 4. Full lead report from water program Type B deficiency was cited, exit interview conducted, and a copy of this report was given and reviewed with the Facility Representative, Thao Nguyen. Appeal rights were reviewed and provided. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS. SUPERVISORS NAME: Diana Stephenson LICENSING EVALUATOR NAME: Harsimran Kaur LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023 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: KIDANGO FOXDALE FACILITY NUMBER: 434415705 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/07/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/14/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Lead Testing Written Directives section 101700.3 (b)(1), a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:1 2 3 4 5 6 7Director, Thao Nguyen stated that they will remediate the exceedances and contact Alpha to retest. Director stated she will send documentation of remidation as well as retesting. 8 9 10 11 12 13 14This exceedance levels found in “I” bubbler and sink was 11 ppb. This poses a potential risk to the Health, Safety, or Personal Rights of 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 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:Diana Stephenson LICENSING EVALUATOR NAME:Harsimran Kaur LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023