UKIAH UNIFIED PRESCHOOL VILLAGE-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 01/20/23, Licensing Program Analyst (LPA), Amy Strother made a case management inspection and met with Site Supervisor, Shelley Hicks (D1). 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 water faucet tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "F" an outdoor drinking fountain, had a reading of 5.8 ppb. All other sources of water tested below the allowable level of 5.0 ppb. LPA Strother received an email from Kristin Hills (A1), Director of Early Learning and Care, Educational Services for Mendocino County Office of Education on 12/12/22 containing the following documents; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999), and a copy of the letter given to parents or authorized representatives of children in care, informing them of the lead testing results, and a photo of the faucet made inaccessible to children. On 01/12/23 LPA Strother emailed a copy of the lead report from the California State Water Resource Control Board to A1, requesting photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999) be submitted within one week, as required. On 01/12/23 LPA received the requested photos. During today’s visit, LPA verified that the test results were posted and that Sample site “F” was made inaccessible to children in care. A1 stated that faucet “F” has been replaced, is in the process of being flushed and will be retested on 02/04/23. D1 stated that children in care are receiving drinking water from a container filled from kitchen faucet "C" and paper cups. The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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 Site Supervisor, Shelley Hicks. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 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: UKIAH UNIFIED PRESCHOOL VILLAGE-PRESCHOOL FACILITY NUMBER: 233003489 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/20/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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 7LPA observed that the facility has temporarily removed the affected faucet “F” from service by way of a plastic cover. A1 stated that the facility has replaced the faucet, is flushing it, with a plan to retest on 02/04/23, submitting test results to LPA at amy.strother@dss.ca.gov by 02/20/23. 8 9 10 11 12 13 14Based on record review, the facility had one faucet (Site “F”) that exceeded that allowable levels of lead in the water (5.8 ppb). This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 D1 stated children in care are receiving drinking water from a container filled from kitchen faucet "C" and paper cups. Testing results have been posted and families have been notified of the plans for remediation. 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:Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023

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 01/20/23, Licensing Program Analyst (LPA), Amy Strother made a case management inspection and met with Site Supervisor, Shelley Hicks (D1). 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 water faucet tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "F" an outdoor drinking fountain, had a reading of 5.8 ppb. All other sources of water tested below the allowable level of 5.0 ppb. LPA Strother received an email from Kristin Hills (A1), Director of Early Learning and Care, Educational Services for Mendocino County Office of Education on 12/12/22 containing the following documents; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999), and a copy of the letter given to parents or authorized representatives of children in care, informing them of the lead testing results, and a photo of the faucet made inaccessible to children. On 01/12/23 LPA Strother emailed a copy of the lead report from the California State Water Resource Control Board to A1, requesting photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999) be submitted within one week, as required. On 01/12/23 LPA received the requested photos. During today’s visit, LPA verified that the test results were posted and that Sample site “F” was made inaccessible to children in care. A1 stated that faucet “F” has been replaced, is in the process of being flushed and will be retested on 02/04/23. D1 stated that children in care are receiving drinking water from a container filled from kitchen faucet "C" and paper cups. The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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 Site Supervisor, Shelley Hicks. SUPERVISORS NAME: Alexis Hollon LICENSING EVALUATOR NAME: Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023 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: UKIAH UNIFIED PRESCHOOL VILLAGE-PRESCHOOL FACILITY NUMBER: 233003489 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 01/20/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/20/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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 7LPA observed that the facility has temporarily removed the affected faucet “F” from service by way of a plastic cover. A1 stated that the facility has replaced the faucet, is flushing it, with a plan to retest on 02/04/23, submitting test results to LPA at amy.strother@dss.ca.gov by 02/20/23. 8 9 10 11 12 13 14Based on record review, the facility had one faucet (Site “F”) that exceeded that allowable levels of lead in the water (5.8 ppb). This is a potential health and safety risk to children in care.8 9 10 11 12 13 14 D1 stated children in care are receiving drinking water from a container filled from kitchen faucet "C" and paper cups. Testing results have been posted and families have been notified of the plans for remediation. 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:Amy Strother LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023

Type B citation - potential risk if not corrected