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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283006886
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:01:30 PM


Document Has Been Signed on 02/15/2023 12:01 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:NCOE - NAPA PRESCHOOL PROGRAMFACILITY NUMBER:
283006886
ADMINISTRATOR:MARYANNE RIJKERSFACILITY TYPE:
850
ADDRESS:74 WINTUN CTTELEPHONE:
(707) 253-6850
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY:120CENSUS: 70DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michele EggertTIME COMPLETED:
12:20 PM
NARRATIVE
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On 02/15/2023, Licensing Program Analyst (LPA), Sebastian Phouthavong made a case management inspection and met with Director, Michele Eggert. 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 A had a reading of 8.90 ppb, Sample H had a reading of 29.00 ppb and Sample Site R had a reading of 33.00 ppb. All other sources of water tested below the allowable level of 5.0 ppb.

During today’s inspection, LPA observed faucets, Simple Site R and Simple Site A to be in the main office; Site R was in the nurse’s room and Site A in the staff break room. Simple H was located in a room where not care is provided. All faucets were all covered and had a “Do Not Use” sign making it inaccessible to day care children. The facility is providing a water dispenser with water jags and bottled waters as potable water. All faucets were at locations where care is not being provided. Director stated the facility plans to permanently remove Sample Site R faucet from the premises. As for Simple Site A and Simple Sate H, Director stated the faucets have been replaced and retested.

During today’s inspection LPA requested the Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999). LPA requested that the facility provide the External Water Sampling Self-Certification Form (LIC 9275) and photos of all water outlets labeled and corresponding to the Facility Sketch (LIC 999).

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 Director, Michele Eggert

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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 02/15/2023 12:01 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: NCOE - NAPA PRESCHOOL PROGRAM
FACILITY NUMBER: 283006886

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2023
Section Cited

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01700.3(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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Facility has made “Site A, Site H & Site R” inaccessible and notified all parents or guardians of the lead testing results. The facility will submit an LIC 9275, LIC 9276, and Facility Sketch. Director stated Site “A” and Site “H” have already been repleaced & retested and Site “R” will be removed from the premises.
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Based on record review, the facility had three faucets (Site “A, H, R”), that exceeded that allowable levels of lead in the water (8.9 ppb, 29.00 ppb and 33.00 ppb). This is a potential health and safety risk to children in care.
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 The facility will submit proof by pictures faucet onces removed, documents of retesting results and required forms to sebastian.phouthavong@dss.ca.gov by 03/15/23.

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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: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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