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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065403221
Report Date: 02/15/2023
Date Signed: 03/30/2023 09:01:24 PM


Document Has Been Signed on 03/30/2023 09:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:COLUSA HEAD STARTFACILITY NUMBER:
065403221
ADMINISTRATOR:MARKSS, VICKIFACILITY TYPE:
850
ADDRESS:728 5TH STREETTELEPHONE:
(530) 458-0340
CITY:COLUSASTATE: CAZIP CODE:
95932
CAPACITY:24CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Donyale MillerTIME COMPLETED:
05:15 PM
NARRATIVE
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On 2/15/2023 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez made a case management inspection and met with CCOE Education Division Manager Donyale Miller. 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 faucet tested above the allowable level (5.5 ppb or greater) of lead in the water:

Faucet “A” – indoor sink with drinking fountain, 9.00 ppb

The following deficiencies are being cited (see LIC 809D). 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.

An exit interview was conducted, and the report was reviewed with CCOE Education Division Manager Donyale Miller .

The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/30/2023 09:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: COLUSA HEAD START
FACILITY NUMBER: 065403221

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited

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California Lead Action Level at Child Care Centers - 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: a record review, the facility has 1
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The preschool is currently not in session and the license has been placed in inactive status. Facility representative agrees to replace and retest the faucet prior to reactivating the license.
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indoor sink with drinking fountain with lead test results at or exceeding 5.5 ppb of lead in the water.

This is a potential health and safety risk to children in care.
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Type B
03/01/2023
Section Cited

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Post -Testing Requirements and Information

This requirement was not met as evidenced by: The licensee failing to provide the required LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form.
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The licensee agrees to provide the LIC9275 External Water Sampler Self-Certification Form and LIC9276 CCC Sampling Checklist Form.

The plan of correction shall be submitted to CCLD on or before 3/1/2023.

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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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