ATCAA - SOULSBYVILLE HEAD START

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 11/08/2022 at 11:00 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Elvira Sierra met with Director, Tiffany Dobbs, to conduct an unannounced case management inspection. The purpose of the inspection was to follow up on a water sampling related to lead in drinking water and food preparation water used at child care centers. There were 5 staff present supervising 14 children. The Regional Office was notified that the lead testing results indicated an Action Level Exceedance (ALE) for a drinking fountain (Outlet B) located in the classroom which was tested on 09/17/2022. On 10/20/2022, the facility was notified that water levels in Outlet B were in exceedance of 5.5 parts per billion (ppb). Director stated Outlet B has not been used since March 2020 in response to COVID-19. Director stated Outlet B was removed from the classroom and capped off. Director stated drinking water is obtained from the kitchen. LPAs verified the affected water outlet was removed and inoperable and observed alternative drinking water available at other outlets within the facility. A deficiency is being cited on the attached LIC 809-D page. An exit interview was conducted and report was reviewed with the Director, Tiffany Dobbs. A notice of site visit was posted and must remain posted for 30 days. SUPERVISORS NAME: Jeanne Smith LICENSING EVALUATOR NAME: Tiffanie Diep LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022 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: AMADOR-TUOLUMNE COMMUNITY ACTION AGENCY HEAD START FACILITY NUMBER: 553601751 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/08/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/08/2022 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (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 stated the affected water outlet has not been used since March 2020. Director stated the outlet was removed from the classroom and capped off. Director stated facility uses the kitchen water oulet for drinking and food preparation. 8 9 10 11 12 13 14Based on record review, the lead testing results indicated an Action Level Exceedance for a drinking fountain located in the classroom which was tested on 09/17/2022. This poses a potential health, safety, or personal rights risk to children in care.8 9 10 11 12 13 14A written statement and documentation of faucet removal will be submitted to LPA by 12/08/2022. 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:Jeanne Smith LICENSING EVALUATOR NAME:Tiffanie Diep LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022

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 11/08/2022 at 11:00 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Elvira Sierra met with Director, Tiffany Dobbs, to conduct an unannounced case management inspection. The purpose of the inspection was to follow up on a water sampling related to lead in drinking water and food preparation water used at child care centers. There were 5 staff present supervising 14 children. The Regional Office was notified that the lead testing results indicated an Action Level Exceedance (ALE) for a drinking fountain (Outlet B) located in the classroom which was tested on 09/17/2022. On 10/20/2022, the facility was notified that water levels in Outlet B were in exceedance of 5.5 parts per billion (ppb). Director stated Outlet B has not been used since March 2020 in response to COVID-19. Director stated Outlet B was removed from the classroom and capped off. Director stated drinking water is obtained from the kitchen. LPAs verified the affected water outlet was removed and inoperable and observed alternative drinking water available at other outlets within the facility. A deficiency is being cited on the attached LIC 809-D page. An exit interview was conducted and report was reviewed with the Director, Tiffany Dobbs. A notice of site visit was posted and must remain posted for 30 days. SUPERVISORS NAME: Jeanne Smith LICENSING EVALUATOR NAME: Tiffanie Diep LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022 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: AMADOR-TUOLUMNE COMMUNITY ACTION AGENCY HEAD START FACILITY NUMBER: 553601751 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/08/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 12/08/2022 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (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 stated the affected water outlet has not been used since March 2020. Director stated the outlet was removed from the classroom and capped off. Director stated facility uses the kitchen water oulet for drinking and food preparation. 8 9 10 11 12 13 14Based on record review, the lead testing results indicated an Action Level Exceedance for a drinking fountain located in the classroom which was tested on 09/17/2022. This poses a potential health, safety, or personal rights risk to children in care.8 9 10 11 12 13 14A written statement and documentation of faucet removal will be submitted to LPA by 12/08/2022. 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:Jeanne Smith LICENSING EVALUATOR NAME:Tiffanie Diep LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022