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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093610400
Report Date: 06/01/2023
Date Signed: 06/01/2023 11:28:23 AM

Document Has Been Signed on 06/01/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AL TAHOE SCHOOL HEAD STARTFACILITY NUMBER:
093610400
ADMINISTRATOR:GUTIERREZ, ROSAFACILITY TYPE:
850
ADDRESS:1100 LYONS AVE. #C5-8TELEPHONE:
(530) 541-0284
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY: 103TOTAL ENROLLED CHILDREN: 103CENSUS: 9DATE:
06/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rosa GutierrezTIME COMPLETED:
11:45 AM
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On June 1st, 2023 Licensing Program Analysts (LPA) Soleil Marx met with Director, Rosa Gutierrez, to conduct an unannounced case management inspection regarding lead testing. During today's inspection there was a census of nine preschool age children with three staff. The purpose of today's inspection was to create a plan of correction following reports of lead exceedance in one of the facility water outlets.

On 05/19/23, the facility tested water samples for lead. The Lead Testing identified one water outlet that has a Lead Exceedance over the amount of 5.5ppb. The water outlet sampled is marked C, which has an exceedance of 6.8ppb.

The water outlet in exceedance is located in classroom C6, which has been vacant and not been utilized by children for the 2022/2023 school year. The facility plans to reopen and use classroom C6 for children during the 2023/2024 school year. The water source sampled C has been shut off and is in inoperable state, making it inaccessible to children. The facility will use alternative water sources for water for children in care when the school opens again in the Fall until the water outlet has been retested and passes. the water outlet in Fall when school resumes and will notify licensing prior to use.


Deficiencies are cited on the subsequent page of the report and are considered a potential threat to the health and safety of children in care, if not corrected.

An exit interview was conducted with Director. LPA provided Director with Appeal Rights, and a Notice of Site Visit was provided that must be posted for 30 days.
Natalie Dunaway
Soleil Marx
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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 06/01/2023 11:28 AM - It Cannot Be Edited


Created By: Soleil Marx On 06/01/2023 at 11:05 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AL TAHOE SCHOOL HEAD START
FACILITY NUMBER: 093610400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/01/2023
Section Cited

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California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Based on record review, one water outlet tested exceeded the allowed 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023


LIC809 (FAS) - (06/04)
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