304371145-3-6-2023-06-CC-DVSA-CPNPGN-20230306101836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371145
Report Date: 03/06/2023
Date Signed: 03/06/2023 10:18:42 AM

Document Has Been Signed on 03/06/2023 10:18 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:	CYPRESS SCHOOL DISTRICT(CYPSD)EARLY LEARNING PROG		FACILITY NUMBER:	304371145
ADMINISTRATOR:	GLASELL, PAMELA		FACILITY TYPE:	850
ADDRESS:	8710 MOODY STREET		TELEPHONE:	(714) 220-6900
CITY:	CYPRESS	STATE: CA	ZIP CODE:	90630
CAPACITY:	48	CENSUS: 22	DATE:	03/06/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Program Manager, Early Program, Pamela Grisell		TIME COMPLETED:	10:30 AM

NARRATIVE

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Licensing Program Analysts (LPAs), Dianna Valdez Santana and Archibaldo Silva conducted an unannounced Case Management visit for the purpose to discuss the Lead Sampling Testing conducted on 1/18/2023. LPAs met with Program Manager, Early Program, Pamela Glasell who was explained the reason for today’s visit. LPA observed 22 children in care at the time of visit.

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 1/18/2023 failed allowable limit for lead. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (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.

Child Care 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 3/3/2022 that the Lead Sample Report was to be posted. LPAs did observe the facility had 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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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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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: CYPRESS SCHOOL DISTRICT(CYPSD)EARLY LEARNING PROG	FACILITY NUMBER: 304371145
	VISIT DATE: 03/06/2023

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Outlet E, the only outlet that tested positive for elevated levels of lead. The outlet is a drinking fountain is located in the pre-k play-yard. Outlet E is a drinking faucet that had a level of 8.3. Currently the site does not have a sign that reads "Do Not Use." But will add a sign before LPAs leave the facility. Outlet E has been inaccessible to children in care by being taped and covered. Children in care bring their own water bottles from home and facility bring in water pitchers from a filtered water system with disposable cups, in addition to the facility having water bottles as alternate water sources.

Based on LPAs interview with staff, review of facility sketch and walk-through, 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 with Pamela Glasell. The report was reviewed and discussed. Appeal Rights were discussed. Director 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.

Facility representative 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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/06/2023 10:18 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: CYPRESS SCHOOL DISTRICT(CYPSD)EARLY LEARNING PROG	FACILITY NUMBER: 304371145
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/06/2023 Section Cited	1 2 3 4 5 6 7	101700.3 (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.	1 2 3 4 5 6 7	During visit, facility had to post the "Do Not Use" signs where outlet E is located. Lead documents will be submitted to LPA via email at dianna.valdezsantana@dss.ca.gov. Parent notification letter was given to parents on 3/3/23 and the letter will be emailed on 3/6/23.
	8 9 10 11 12 13 14	This requirement is not met evidenced by record review of the lab report analysis from Outlet E taken on 1/18/2023. Results indicated levels of lead in exceedance. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14	Administration will retest, replace or repair outlet E and will submit resampling results to LPA. Please refer to the 101704 Lead Action Level Exceedance Response Requirements PIN provided today.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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