TRACY UNIFIED SCHOOL DISTRICT - NORTH PRESCHOOL

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 March 20, 2023, Licensing Program Analyst (LPA) Stacey Williams met with School Readiness Lead, Rebecca Silva for an unannounced Case Management Inspection. LPA observed 19 children being cared for by 4 staff members. The purpose of today’s inspection was to follow up regarding a water sampling that indicated Action Level Exceedances (ALEs) in one outlet that was tested for lead levels on 2/15/2023. On 03/6/2023 the facility was notified that water levels were in exceedance of 5 parts per billion in drinking fountain (fixture A). Fixture A is located in the primary classroom associated with license #393614190. All exceedances are being addressed in this report. Since receiving the notification School Readiness Lead advised that the water fountain in Fixture A has not been in use since April of 2021. Fixture A was permanently ceased and removed. Children bring their own water. Water is replenished by way of usage of bottled water. LPA informed School Readiness Lead that Grant funding for testing and remediation is available and information can be found in Provider Information Notice (PIN) 21-04-CCP. A Type B deficiency was cited on the subsequent page (LIC809-D) of this report. An Exit interview conducted, and the report was reviewed and provided to School Readiness . LPA posted the Notice of Site Visit and Director acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Stacey Williams LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023 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 2 FACILITY NAME: TRACY UNIFIED SCHOOL DISTRICT - NORTH PRESCHOOL FACILITY NUMBER: 393614190 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/20/2023 Section Cited 101700.3(c) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (c) If testing indicates an...Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response...shall be required. This requirement was not as evidenced by:1 2 3 4 5 6 7LPA observed that outlet A has been permanently ceased and removed. School Readiness Lead has also advised that outlet A has not been used since April of 2021. 8 9 10 11 12 13 14Lead test results received by Licensing on 03/15/2023, tested on 2/15/2023, showed outlet A in the facility with lead levels exceeding 5 parts per billion (ppb). This poses a potential risk to the health and safety 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:Bettina Engelman LICENSING EVALUATOR NAME:Stacey Williams LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023

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 March 20, 2023, Licensing Program Analyst (LPA) Stacey Williams met with School Readiness Lead, Rebecca Silva for an unannounced Case Management Inspection. LPA observed 19 children being cared for by 4 staff members. The purpose of today’s inspection was to follow up regarding a water sampling that indicated Action Level Exceedances (ALEs) in one outlet that was tested for lead levels on 2/15/2023. On 03/6/2023 the facility was notified that water levels were in exceedance of 5 parts per billion in drinking fountain (fixture A). Fixture A is located in the primary classroom associated with license #393614190. All exceedances are being addressed in this report. Since receiving the notification School Readiness Lead advised that the water fountain in Fixture A has not been in use since April of 2021. Fixture A was permanently ceased and removed. Children bring their own water. Water is replenished by way of usage of bottled water. LPA informed School Readiness Lead that Grant funding for testing and remediation is available and information can be found in Provider Information Notice (PIN) 21-04-CCP. A Type B deficiency was cited on the subsequent page (LIC809-D) of this report. An Exit interview conducted, and the report was reviewed and provided to School Readiness . LPA posted the Notice of Site Visit and Director acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100. SUPERVISORS NAME: Bettina Engelman LICENSING EVALUATOR NAME: Stacey Williams LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023 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 2 FACILITY NAME: TRACY UNIFIED SCHOOL DISTRICT - NORTH PRESCHOOL FACILITY NUMBER: 393614190 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/20/2023 Section Cited 101700.3(c) 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (c) If testing indicates an...Exceedance at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response...shall be required. This requirement was not as evidenced by:1 2 3 4 5 6 7LPA observed that outlet A has been permanently ceased and removed. School Readiness Lead has also advised that outlet A has not been used since April of 2021. 8 9 10 11 12 13 14Lead test results received by Licensing on 03/15/2023, tested on 2/15/2023, showed outlet A in the facility with lead levels exceeding 5 parts per billion (ppb). This poses a potential risk to the health and safety 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:Bettina Engelman LICENSING EVALUATOR NAME:Stacey Williams LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023

Type B citation - potential risk if not corrected