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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330911336
Report Date: 01/06/2023
Date Signed: 01/06/2023 10:10:26 AM


Document Has Been Signed on 01/06/2023 10:10 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:DSUSD/EISENHOWER ECE CENTERFACILITY NUMBER:
330911336
ADMINISTRATOR:IFTHIKA NISSARFACILITY TYPE:
850
ADDRESS:83-391 DILLON AVENUETELEPHONE:
(760) 775-3815
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY:40CENSUS: 14DATE:
01/06/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Jessica CuevasTIME COMPLETED:
10:30 AM
NARRATIVE
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On January 6, 2023 , Licensing Program Analysts (LPA’s ) Lorena Valenzuela and Jeanette Sanchez made an unannounced Case Management inspection, for reported Lead Exceedance at the facility’s water. LPA's met with teacher Lorena Eudave and teacher/site supervisor Jessica Cuevas, and proceeded to tour the facility. Also present in the facility were 14 daycare children and 3 teachers/staff. Facility was within ratio & capacity. Staff members have the required background clearances.

LPA interviewed staff and examined the faucet deemed an Action Level Exceedance. On 11/15/2022, the facility provided the Department the facility sketch with labeled water outlets and the required signed and dated External Water Sampler Self- Certification (LIC 9275) and Child Care Sampling Checklist (LIC 9276) forms. Per records review, the facility had the water sampled for lead on 09/28/2022. Faucets reported with 5.5 ppb (parts per billion) or greater lead exceedance levels were as follows:

Water fountain/ labeled A located in room K-23 5.93 ppb

All other fountains and water outlets tested within an acceptable level with no lead exceedance. Parents were notified via a letter sent to parents/guardians.At the time of the inspection, LPA’s observed water outlet labeled A was bagged and taped to prevent the faucet from being used by children and staff.

Per staff interviews the water faucet labeled A was being used to provide drinking water to children in care. Staff interviews revealed that classroom K-23 is a socialization class where currently 5 children are enrolled and attendance is voluntary. Per staff interview, the classroom is used once a month by children who participate.

Based on records review and information received, and current policies and procedures for the Department, the facility is being cited for having a lead exceedance in water fountain labeled letter A, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers.

Exit interview conducted and report was reviewed with Jessica Cuevas. A notice of site visit was given and must remain posted for 30 days. LPA observed Jessica Cuevas post notice of site visit.

SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
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 2


Document Has Been Signed on 01/06/2023 10:10 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: DSUSD/EISENHOWER ECE CENTER
FACILITY NUMBER: 330911336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2023
Section Cited

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101700.3 (b) (1) Written Directives...A result
with values of 5.5 ppb or greater shall be
deemed an Action Level Exceedance.
This requirement was not met as evidence by:
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Per telephone conversation, with Director Jay Rallion will permanently remove water outlet labeled A and send proof to the Department by due date 01/20/2023.
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Based on water testing results, interviews and records review, facility tested over the Action Level Exceedance, in one water outlet labeled A which is used for drinking water. This poses a potential health, safety, or personal rights risk to the children in care.
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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: Stephanie HudakTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
LIC809 (FAS) - (06/04)
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