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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173007240
Report Date: 02/16/2023
Date Signed: 02/16/2023 09:32:24 AM


Document Has Been Signed on 02/16/2023 09:32 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ALPHABET SOUP CHILDREN'S LEARNING CENTERFACILITY NUMBER:
173007240
ADMINISTRATOR:HODGES, CONNIEFACILITY TYPE:
850
ADDRESS:21075 BUSH STREETTELEPHONE:
(707) 987-0131
CITY:MIDDLETOWNSTATE: CAZIP CODE:
95461
CAPACITY:27CENSUS: 22DATE:
02/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Owners, Connie and Judon HodgesTIME COMPLETED:
10:00 AM
NARRATIVE
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On 02/16/2023, Licensing Program Analyst (LPA), Sebastian Phouthavong made a case management inspection and met with Owners, Connie and Judon Hodges. The inspection was made in response to water lead testing results received from the facility. The test results showed that the following simples tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site B had a reading of 5.9 ppb. All other sources of water tested below the allowable level of 5.0 ppb.

During today’s inspection, LPA observed the drinking fountain to be already covered and inaccessible to day care children. The facility is providing a water jug and individual cups for the children for potable water. Owners stated they will conduct the sampling company to received information to see if can retest, but their main plan will be to remove the “Site B” drinking fountain from the premises.

During today’s inspection, the facility has submitted the External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to CCL.

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 Licensee, Elisa Young

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
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


Document Has Been Signed on 02/16/2023 09:32 AM - 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: ALPHABET SOUP CHILDREN'S LEARNING CENTER
FACILITY NUMBER: 173007240

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
Section Cited

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101700.3(b)(1) A result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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The facility has made Site “B” inaccessible and notify all parents or guardians of the lead testing results. Owners stated they will conduct the sampling company to received information to see if can retest,
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Based on record review, the facility had one faucet (Site “B”), that exceeded that allowable levels of lead in the water (5.9 ppb). This is a potential health and safety risk to children in care.
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if cannot, will plan will be to remove the “Site B” drinking fountain from the premises. The facility will submit proof of completion by pictures/documents to sebastian.phouthavong@dss.ca.gov by 03/16/23.

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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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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