W.C.C.U.S.D. - RIVERSIDE SCHOOL

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 Wednesday, January 18, 2023 10:04 AM, Licensing Program Analyst (LPA) Caroline Colson met with Anna Wirsig, Head Teacher, for a case management inspection for Lead Testing Results. Demi Branch, Early Learning Program Supervisor and Olanrewaju Ajayi, Early Learning Program Preschool Coordinator. There are 21 preschool children and 3 staff members including head teacher. A tour of the facility was conducted. Test Results were obtained. It was concluded that there is one faucet located behind the director's desk that has elevated lead levels established by an certified independent water sampler. Please See LIC 809 D for Deficiency A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Olanrewaju Ajayi, Early Learning Program Preschool Coordinator. SUPERVISORS NAME: Mayla Mendoza LICENSING EVALUATOR NAME: Caroline Colson LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023 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: W.C.C.U.S.D. - RIVERSIDE SCHOOL FACILITY NUMBER: 073402755 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/18/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/20/2023 Section Cited CCR 101700.3(b) 1 2 3 4 5 6 7Lead Testing Written Directive A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 1 2 3 4 5 6 7BY POC DUE DATE: Licensee repaired the faucet but will need to have it reinspected for new results. 8 9 10 11 12 13 14Based on record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.8 9 10 11 12 13 14Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected. 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:Mayla Mendoza LICENSING EVALUATOR NAME:Caroline Colson LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023

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 Wednesday, January 18, 2023 10:04 AM, Licensing Program Analyst (LPA) Caroline Colson met with Anna Wirsig, Head Teacher, for a case management inspection for Lead Testing Results. Demi Branch, Early Learning Program Supervisor and Olanrewaju Ajayi, Early Learning Program Preschool Coordinator. There are 21 preschool children and 3 staff members including head teacher. A tour of the facility was conducted. Test Results were obtained. It was concluded that there is one faucet located behind the director's desk that has elevated lead levels established by an certified independent water sampler. Please See LIC 809 D for Deficiency A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Olanrewaju Ajayi, Early Learning Program Preschool Coordinator. SUPERVISORS NAME: Mayla Mendoza LICENSING EVALUATOR NAME: Caroline Colson LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023 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: W.C.C.U.S.D. - RIVERSIDE SCHOOL FACILITY NUMBER: 073402755 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/18/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/20/2023 Section Cited CCR 101700.3(b) 1 2 3 4 5 6 7Lead Testing Written Directive A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 1 2 3 4 5 6 7BY POC DUE DATE: Licensee repaired the faucet but will need to have it reinspected for new results. 8 9 10 11 12 13 14Based on record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.8 9 10 11 12 13 14Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected. 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:Mayla Mendoza LICENSING EVALUATOR NAME:Caroline Colson LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023