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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803956
Report Date: 12/13/2022
Date Signed: 12/13/2022 09:23:13 AM

Document Has Been Signed on 12/13/2022 09:23 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 CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334803956
ADMINISTRATOR:RFACILITY TYPE:
850
ADDRESS:47-950 DUNE PALMS ROADTELEPHONE:
(760) 771-8650
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 23DATE:
12/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Jay RallionTIME COMPLETED:
09:35 AM
NARRATIVE
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On December 13, 2022, Licensing Program Analyst (LPA) Lorena Valenzuela made an unannounced case management inspection to follow up on the visit conducted at the facility on 11/18/2022 regarding the reported Lead Exceedance in the facility’s water. LPA Valenzuela met with Director Jay Rallion.
Per records review, the facility had the water sampled for lead on 09/29/2022. Based on the water sample taken on 09/29/2022, water outlet reported 5.5 ppb (parts per billion) or greater lead exceedance levels as follows:
Outdoor drinking water fountain- labeled letter B – 9.16 ppb
During the visit on 11/18/2022, LPA Valenzuela observed that there was no cover or sign preventing children from using the outdoor drinking water fountain labelled letter B. Records reviewed indicated that on 10/11/2022, the facility was notified of the high lead test results in water fountain labeled letter B and the facility did not ensure the outlet was made unavailable for use by children in care. After advised by LPA on 11/18/2022, the facility covered the water outlet labelled letter B with a plastic bag and made inaccessible.
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 B, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers. See deficiency report, LIC809D for Type A deficiency issued.
LPA Lorena Valenzuela informed Jay Rallion that this report dated 12/13/2022, document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lorena Valenzuela informed the Jay Rallion to provide a copy of this licensing report dated 12/13/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with Director Jay Rallion. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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 12/13/2022 09:23 AM - It Cannot Be Edited


Created By: Lorena Valenzuela On 12/13/2022 at 08:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DSUSD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 334803956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/13/2022
Section Cited

101700.3(b)(1)

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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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Director removed water fountain labelled letter B, plan of correction cleared at time of inspection.
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Based records review and information received, facility tested over the Action Level Exceedance, in water outlet labelled B. This poses an immediate 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 Hudak
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


LIC809 (FAS) - (06/04)
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