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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370274
Report Date: 12/14/2022
Date Signed: 12/14/2022 10:02:37 AM


Document Has Been Signed on 12/14/2022 10:02 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:PLUMFIELD PRE-SCHOOLFACILITY NUMBER:
304370274
ADMINISTRATOR:CORDOBA, KIMBERLY B.FACILITY TYPE:
850
ADDRESS:2112 E. SANTA CLARA AVE.TELEPHONE:
(714) 547-5771
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:70CENSUS: 29DATE:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kimberly Cordoba - DirectorTIME COMPLETED:
10:10 AM
NARRATIVE
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Licensing Program Analyst (LPA) Odom conducted an unannounced Case Management visit. LPA Odom met with Director Kimberly Cordoba, took a tour of the facility and took census, LPA observed 4 staff members and 29 preschool age children. LPA discussed the Lead Sampling Testing conducted on 10/12/22 with Director. LPA Odom ensured the Lead Sample Report is posted. Licensee was advised on 12/12/22 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 E is a drinking fountain in the Art Room that will be remediated, the drinking fountain was closed off with tape. Outlet H is an outdoor drinking fountain in the Playground that will be remediated, the drinking fountain was closed off with tape. Director stated they plan to remediate the outlets, the faucets will be replaced on 12/14/22, flushed for 3 weeks and director will schedule to retest the outlets. Source of drinking water is children’s water bottles brought from home and refilled by staff using filtered Arrowhead water jugs.

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.

Exit interview conducted and report was reviewed with the Director Kimberly Cordoba. 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: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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 12/14/2022 10:02 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: PLUMFIELD PRE-SCHOOL
FACILITY NUMBER: 304370274

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/14/2022
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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Director posted the lead sampling test results. Director closed off the outlets with tape. Director is utilizing filtered Arrowhead water jugs as another source of water and using personal water bottles as source of drinking water. Director stated they will replace the faucets and will schedule a test date. Director submitted Lead licensing forms and sketch to
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Based on facility Lead sampling tests it was discovered that Outlets E and H had high level of lead. This poses a potential risk to the health of children in care.
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licensing department on 10/24/22.

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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: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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