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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009437
Report Date: 12/06/2022
Date Signed: 12/06/2022 11:26:18 AM


Document Has Been Signed on 12/06/2022 11:26 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:LITTLE BACKPACKS PRESCHOOL-INFANTFACILITY NUMBER:
283009437
ADMINISTRATOR:KEENER, KATIEFACILITY TYPE:
830
ADDRESS:995 ADAMS STREETTELEPHONE:
(707) 963-4705
CITY:ST. HELENASTATE: CAZIP CODE:
94574
CAPACITY:12CENSUS: 2DATE:
12/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Ana Saldana, Lead DirectorTIME COMPLETED:
11:40 AM
NARRATIVE
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On 12/06/2022 at 10:41am, Licensing Program Analyst (LPA), Kevin O'Connell made a case management inspection and met with Facility Representative, Ana Saldana. Director Katie Keener was not available during today's visit.
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 (5.5 ppb) of lead in the water:
Faucet "A" - "sink faucet", 5.500 ppb
Faucet "D" - "sink faucet", 7.700 ppb

The staff have made the sink faucets inaccessible by:
Placing a bag over the faucet and posting a sign stating " Do not use until removed by sampler- failure to comply will negatively impact ongoing lead sampling work required by California State Law".
Faucet "A" was not used and in a room that was not used for care.
Faucet "D" was used for washing hands and refilling children's water bottles.
Since the test results this room is now using bottled water to refill children's water bottles.
The facility is in the process of replacing all affected faucets per the recommendations of the water test company. A re sampling of the water will be made after the faucets are replaced. 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 Director, Ana Saldana.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022
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 12/06/2022 11:26 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: LITTLE BACKPACKS PRESCHOOL-INFANT
FACILITY NUMBER: 283009437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2023
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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Based on record review, the facility had 2 faucets that exceeded the allowable levels of lead in the water (5.5 ppb or higher). This is a potential health and safety risk to children in care.
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and children bring their own water and receive refills of drinking water from store bought water. The facility manager is in the process of replacing the affected faucets and will retest, notify,
and send results to CCL by 01/03/23.
cclrpregionalofficegeneral@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: 12/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022
LIC809 (FAS) - (06/04)
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