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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125400309
Report Date: 06/30/2022
Date Signed: 06/30/2022 01:34:02 PM


Document Has Been Signed on 06/30/2022 01:34 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:HEAD START - MCKINLEYVILLEFACILITY NUMBER:
125400309
ADMINISTRATOR:ZINSELMEIR, KATHLEENFACILITY TYPE:
850
ADDRESS:1460 HILLER ROADTELEPHONE:
(707) 839-3648
CITY:MCKINLEYVILLESTATE: CAZIP CODE:
95519
CAPACITY:55CENSUS: 0DATE:
06/30/2022
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Naomi Faulkner/Abraxas LaytonTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/30/2022 at 9:00 AM, Licensing Program Analyst (LPA) Kiriko Lynch made a collateral inspection and met with Naomi Faulkner and Abraxas Layton. 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 (5.5 ppb) of lead in the water:

- McKinleyville State Program Classroom:
Fixture “B” – children’s drinking fountain, 14 ppb
- McKinleyville Head Start Classroom:
Fixture “G” – children’s drinking fountain, 6.1 ppb
- McKinleyville Facility Site:
Fixture “I” – adult restroom handwashing sink, 11 ppb

The staff have made the fixtures inaccessible by: Facility staff have wrapped the two drinking fountains in plastic and tape. Facility representative stated the fountain are both shut off and have not been used since the start of the Covid-19 pandemic. Facility representative stated the two fountains were removed and replaced on 01/18/2022 and will be retested on 07/02/2022. Children in care are receiving drinking water from dispensers and disposable cups filled with water from the facility kitchen sink. Facility representative stated the adult restroom handwashing faucet will not be replaced and a permanent sign will be posted at the fixture for handwashing only, no potable water available. LPA noted that facility stated this adult restroom fixture was tested due to lead tester’s discretion, and not mandated by the regulations.

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 facility representatives Naomi Faulkner and Abraxas Layton.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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 06/30/2022 01:34 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: HEAD START - MCKINLEYVILLE
FACILITY NUMBER: 125400309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/01/2022
Section Cited

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Buildings and Grounds - The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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Based on record review, the facility had fixture(s) that exceeded allowable levels of lead in the water. This is a potential health and safety risk to children 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
LIC809 (FAS) - (06/04)
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