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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280111518
Report Date: 07/01/2022
Date Signed: 07/01/2022 11:07:54 AM

Document Has Been Signed on 07/01/2022 11:07 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 - MENLO CENTERFACILITY NUMBER:
280111518
ADMINISTRATOR:ARACELI SOTOFACILITY TYPE:
850
ADDRESS:1551 MYRTLE AVENUETELEPHONE:
(707) 396-0080
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 68TOTAL ENROLLED CHILDREN: 68CENSUS: DATE:
07/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Araceli Soto, Site DirectorTIME COMPLETED:
11:20 AM
NARRATIVE
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On 7/01/2022 at 10:00am, Licensing Program Analyst (LPA), Kevin O'Connell made a case management inspection and met with Director, Araceli Soto . 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 ppb) of lead in the water:
Faucet "E" - Menlo 2, classroom B "sink", 8.600 ppb
The staff have made the faucet inaccessible by
closing off the room to children. This classroom is not in use and has not been used since 5/26/22 when summer sessions started. They plan to reopen the classroom on 8/17/22 for fall classes.
The faucet was replaced on 6/20/22 per the recommendations of the water test company. They will take a re-sample on 7/11/22 and 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 Director Araceli Soto.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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 07/01/2022 11:07 AM - It Cannot Be Edited


Created By: Kevin O'Connell On 07/01/2022 at 10:53 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEAD START - MENLO CENTER
FACILITY NUMBER: 280111518

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
101238(a)

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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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The Licensee posted a sign above the hand washing faucet. The Licensee replaced the faucet piece and it will be retested on 7/11/22.
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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 sampling-7/25/22.

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 Lepori
LICENSING EVALUATOR NAME:Kevin O'Connell
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
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