NCO HEAD START - CHILD DEV. CTR. - S. UKIAH

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 9/7/23 at 9:53 am, Licensing Program Analyst (LPA), Robert Maciel made a case management inspection and met with Administrator Kathy Stuart. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water: Faucet “A” – children's outdoor drinking fountain, 6.8ppb The staff have made the faucet inaccessible by placing a bucket bound with caution tape over the faucet. Children in care are receiving drinking water from individual water bottles provided by the facility. The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Administrator Kathy Stuart. Appal Rights were given. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Robert Maciel LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023 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: NCO HEAD START - CHILD DEV. CTR. - S. UKIAH FACILITY NUMBER: 233001386 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/07/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/05/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement was not met as evidenced by: On 7/26/23, licensee failed to maintain a lead1 2 3 4 5 6 7Licensee has made the faucets temporarily inaccessible by shutting the water off, and children receive drinking water from bottled water. 8 9 10 11 12 13 14 value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for faucet "A". Water testing results identified with Action Level Exceedance as defined in WD section 101700.3. are not deemed safe to drink. This is a potential health and safety risk to children in care. 8 9 10 11 12 13 14The licensee will determine if the faucet will be replaced and retested or permanently removed by POC date and will submit plans regarding how that will be accomplished by 9/20/23. 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:Alexis Hollon LICENSING EVALUATOR NAME:Robert Maciel LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023

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 9/7/23 at 9:53 am, Licensing Program Analyst (LPA), Robert Maciel made a case management inspection and met with Administrator Kathy Stuart. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water: Faucet “A” – children's outdoor drinking fountain, 6.8ppb The staff have made the faucet inaccessible by placing a bucket bound with caution tape over the faucet. Children in care are receiving drinking water from individual water bottles provided by the facility. The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Administrator Kathy Stuart. Appal Rights were given. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Robert Maciel LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023 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: NCO HEAD START - CHILD DEV. CTR. - S. UKIAH FACILITY NUMBER: 233001386 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/07/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/05/2023 Section Cited 101700.3(b)(2) 1 2 3 4 5 6 7Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement was not met as evidenced by: On 7/26/23, licensee failed to maintain a lead1 2 3 4 5 6 7Licensee has made the faucets temporarily inaccessible by shutting the water off, and children receive drinking water from bottled water. 8 9 10 11 12 13 14 value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for faucet "A". Water testing results identified with Action Level Exceedance as defined in WD section 101700.3. are not deemed safe to drink. This is a potential health and safety risk to children in care. 8 9 10 11 12 13 14The licensee will determine if the faucet will be replaced and retested or permanently removed by POC date and will submit plans regarding how that will be accomplished by 9/20/23. 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:Alexis Hollon LICENSING EVALUATOR NAME:Robert Maciel LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023

Type B citation - potential risk if not corrected