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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280102626
Report Date: 07/13/2022
Date Signed: 07/13/2022 09:56:37 AM


Document Has Been Signed on 07/13/2022 09:56 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:HEAD START - FULLER PARK CENTERFACILITY NUMBER:
280102626
ADMINISTRATOR:JULIA RIOSFACILITY TYPE:
850
ADDRESS:FULLER PARK, LAUREL STREETTELEPHONE:
(707) 758-1596
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:20CENSUS: 0DATE:
07/13/2022
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Miguel Campos, Facility SupervisorTIME COMPLETED:
10:10 AM
NARRATIVE
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On 7/13/2022 at 08:55am, Licensing Program Analyst (LPA), Kevin O'Connell made a case management inspection and met with Facilities Supervisor, Miguel Campos. This was an announced inspection as the facility has been closed since May 30th for summer break and will reopen in mid-August as this facility follows the local school calendar.

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 outlets/faucets tested above the allowable level (5 ppb) of lead in the water:
Faucet "C" - "kitchen sink faucet", 5.600 ppb
The staff have made the kitchen sink faucet inaccessible by:
the facility was closed to children after the test results were received.
The faucet was replaced on 6/20/22 per the recommendations of the water test company. They were scheduled to take a re-sample on 7/23/22. The facility will update CCL when they receive the results.

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 Facilities Supervisor, Miguel Campos.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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 07/13/2022 09:56 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: HEAD START - FULLER PARK CENTER
FACILITY NUMBER: 280102626

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2022
Section Cited

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Buildings and Grounds 101238(a) The child care center shall be
clean, safe, sanitary and in good repair at all times to
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ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
Based on record review, the facility had 1 faucet that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care.
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Retesting documents will be submitted within 2 weeks of the completed test sampling of 7/23/22 which will be 8/6/22.

kevin.oconnell@dss.ca.gov

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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: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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