300614013-8-30-2022-06-CC-DVSA-CHSUAX-20220830152528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300614013
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:25:37 PM

Document Has Been Signed on 08/30/2022 03:25 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GARDEN GROVE UNIFIED SCHOOL DISTRICT/HERITAGE		FACILITY NUMBER:	300614013
ADMINISTRATOR:	LOBERGER, RYAN		FACILITY TYPE:	850
ADDRESS:	426 SOUTH ANDRES PLACE, ROOM 7		TELEPHONE:	(714) 663-6108
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	48	CENSUS:	DATE:	08/30/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Ryan Loberger		TIME COMPLETED:	03:45 PM

NARRATIVE

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Licensing Program Analysts, Dianna Valdez-Santana and Mila Quinto conducted an unannounced Case Management visit for the purpose to discuss the Lead Sampling Testing conducted on 08/10/2022. LPAs met with Principal Ryan Loberger, who was explained the reason for today’s visit. LPAs observed 4 staff and 11 preschool children in care.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

Community Care Licensing was notified that lead water testing conducted at the facility on 08/10/2022 failed allowable limit for lead. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedances (ALE).

Instructions for required lead testing are outlined in PIN 21-21-CCP. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

Care Child Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in parts per billion (ppb) unit of measurement.

Facility staff was advised on 08/29/2022 that the Lead Sample Report was to be posted. LPAs observed the facility had not posted the Lead Sample Report.

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantana	TELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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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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: GARDEN GROVE UNIFIED SCHOOL DISTRICT/HERITAGE	FACILITY NUMBER: 300614013
	VISIT DATE: 08/30/2022

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On 08/30/22 LPA spoke with Principal, Mr. Loberger, who stated that two outlets had ALE over 5.0 had been made inaccessible to children via bagged and covered with plastic. Based on the report received from the facility, the drinking fountain/sink located in Room 6,the the faucet was replaced on 8/23/22 and resampled on 8/24/22 and passed for no high levels of lead. The drinking spout was also resampled on 8/24/22 and it still tested for elevated levels of lead. Spout was bagged and taped off to ensure inaccessibility. The outlet in Room 5 is a drinking fountain/sink and it was replaced on 8/23/22 and resampled on 8/24/22 and passed with no high levels of lead. Principal reports they use water from the sinks that passed with no high levels of lead and children also bring their own water bottles as alternate water sources.

Based on LPAs staff interviews, review of facility sketch and walkthrough and review of the “Analytical Lead Test Results” documents, the following violation was observed and is being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 3, Section 101238(a) Buildings and Grounds is being cited on the attached LIC 809D.

Exit interview conducted with Principal, Ryan Lobereger the report was reviewed and discussed. Appeal Rights were discussed. Facility staff was provided copy of their appeal rights (lic 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received the Regional Office within 15 business days.

The staff was informed that the "Notice of Site Visit" must be posted for 30 consecutive days. The Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantana	TELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/30/2022 03:25 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GARDEN GROVE UNIFIED SCHOOL DISTRICT/HERITAGE	FACILITY NUMBER: 300614013
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/30/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 09/30/2022 Section Cited	1 2 3 4 5 6 7	101238 Building and Grounds (a) The Child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement not met as evidence by:
	8 9 10 11 12 13 14	Based on lab report analysis water from Room 6 drinking fountain tested on 8/24/22 had a level of 8.86 ppb (parts per billion) . These faucets samples indicate levels of lead in exceedance.	8 9 10 11 12 13 14	Children bring their own bottled water and utilize the other PASS sinks readily available for the staff and children. The facility stated that they will submit new restest results to LPA via email to dianna.valdezsantana@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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantana	TELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC809 (FAS) - (06/04)

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