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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600491
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:49:23 AM


Document Has Been Signed on 11/10/2022 10:49 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:HUNTINGTON VALLEY PRE-SCHOOLFACILITY NUMBER:
300600491
ADMINISTRATOR:VALENZUELA, JODIFACILITY TYPE:
850
ADDRESS:9779 STARFISH AVENUETELEPHONE:
(714) 963-9885
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:124CENSUS: 22DATE:
11/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jodi Valenzuela - DirectorTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Odom conducted an unannounced Case Management visit. LPA Odom met with Director Jodi Valenzuela, took a tour of the facility and took census, LPA observed 3 staff members and 22 preschool age children. LPA discussed the Lead Sampling Testing conducted on 10/11/22 with Director. LPA Odom ensured the Lead Sample Report is posted. Licensee was advised on 11/08/22 the Lead Sample Report was to be posted; LPA confirmed the Licensee posted the Sample Report.

Director stated the outlets with high levels of Lead are inoperable. Outlet A is a drinking fountain in the Preschool Building in Rm #1 has been permanently removed. Outlet D is a Kitchen sink in the Kitchen that will be remediated, faucet has been replaced and staff are currently running the water 4 times per day for 1 minute. Kitchen staff are currently using Outlet B that tested negative for lead for food preparation. Outlet F is a classroom sink in Building CE in Rm #1 that will be remediated, faucet has been replaced and staff are currently running the water 4 times per day for 1 minute, classroom in currently not in use. Outlet G is a classroom sink in Building CE in Rm #2 that will be remediated, faucet has been replaced and staff are currently running the water 4 times per day for 1 minute, classroom in currently not in use. Outlet H is a classroom sink in Building CE in Rm #3 that will be remediated, faucet has been replaced and staff are currently running the water 4 times per day for 1 minute, classroom in currently not in use. Outlet I is a classroom sink in Building CE in Rm #4 that will be remediated, faucet has been replaced and staff are currently running the water 4 times per day for 1 minute. Director stated the are scheduled to retest their outlets on 11/29/22. Source of drinking water is children’s water bottles brought from home and refilled by staff using pitchers with filtered water from the kitchen Outlet C that tested negative for lead.

Based on LPAs record reviews the following violation was observed and is being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 3, Section 101700.3 California Lead Action Level at Child Care Centers is being cited on the attached LIC 809D.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HUNTINGTON VALLEY PRE-SCHOOL
FACILITY NUMBER: 300600491
VISIT DATE: 11/10/2022
NARRATIVE
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Exit interview conducted and report was reviewed with the Director Jodi Valenzuela. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/10/2022 10:49 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: HUNTINGTON VALLEY PRE-SCHOOL
FACILITY NUMBER: 300600491

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2022
Section Cited

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (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 facility Lead sampling tests it was discovered that Outlets A, D, F, G, H, and I had high level of lead. This poses a potential risk to the health of children in care.
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currently running the water 4 times per day for 1 minute.
Director will send the retest results after 11/29/22.

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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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