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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233004123
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:38:51 PM


Document Has Been Signed on 01/12/2023 01:38 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ARENA STATE PRESCHOOLFACILITY NUMBER:
233004123
ADMINISTRATOR:SCHMITZ, KERRIFACILITY TYPE:
850
ADDRESS:20 SCHOOL STREET CLASSROOM #1TELEPHONE:
(707) 882-2131
CITY:POINT ARENASTATE: CAZIP CODE:
95468
CAPACITY:24CENSUS: 10DATE:
01/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Anissa MurphyTIME COMPLETED:
01:45 PM
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On 01/12/23, Licensing Program Analyst (LPA), Amy Strother conducted a case management tele-inspection with Director, Anissa Murphy (D1). Due to severe winter storms with high wind and flooding the Department has approved a virtual inspection. D1 agreed to conduct the visit using FaceTime with LPA for the Tele-Inspection. 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 faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site, "D" an indoor hand washing faucet had a reading of 5.6 (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 01/03/23 stating that the faucet has been shut off and made inoperable since 12/09/22 when the facility first received the results from the lab. A1’s email further stated that families were notified, and the results were posted at the center on 12/09/22 and they are currently working with the school district to get the faucet replaced and retested.

LPA obtained the following documents from A1 via email on 01/03/23; 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, dated 12/09/22. On 01/04/23 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) to be submitted within one week, as required.

During today’s visit, LPA verified that the test results were posted and that Sample site “D” was made inoperable and inaccessible to children in care. D1 stated that faucet has been replaced and in the process of being flushed, with the plan to retest. D1 stated that children in care are receiving drinking water from drinking fountains or bottled water.

Continue on LIC809-C

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ARENA STATE PRESCHOOL
FACILITY NUMBER: 233004123
VISIT DATE: 01/12/2023
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The following deficiency is being cited (see LIC 809D). Appeal Rights were provided via email. A notice of site visit was given via email 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 Director, Anissa Murphy

D1’s signature was not recorded on this LIC809, LIC809-C and LIC809-D; however, D1 was provided with a copy of the LIC809, LIC809-C and LIC809-D; and D1’s confirmation of read receipt is on file.

The report was also emailed to A1.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/12/2023 01:38 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: ARENA STATE PRESCHOOL
FACILITY NUMBER: 233004123

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2023
Section Cited

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101700.3(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:
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LPA observed that the facility has made the affected faucet “D” inaccessible by taping it off and posting a sign the reads, "out of order". D1 stated that the facility has replace the faucet, is flushing it and plans to retest, submitting results to LPA at amy.strother@dss.ca.gov by 02/12/23.
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Based on record review, the facility had one faucet (Site “D”) that exceeded the allowable levels of lead in the water (5.6ppb). This is a potential health and safety risk to children in care.
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D1 stated children in care are receiving drinking water from drinking fountains or bottled water.

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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