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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 04/24/2024
Date Signed: 04/24/2024 03:24:40 PM


Document Has Been Signed on 04/24/2024 03:24 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:SJUSD-HYATT HEAD START STATE PRESCHOOLFACILITY NUMBER:
334811701
ADMINISTRATOR:ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:400 E. SHAVERTELEPHONE:
(951) 487-0526
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:108CENSUS: 74DATE:
04/24/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Elizabeth ZaragozaTIME COMPLETED:
03:32 PM
NARRATIVE
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On April 24, 2024 at 2:31 PM, Licensing Program Analyst (LPA) Cindy Hamilton, conducted a Case Management visit in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA met with Elizabeth Zaragoza, Director who was informed of the reason for the visit.

Assembly Bill 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers constructed before January 1, 2010, to test their drinking and cooking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. LPA observed on the report provided by the SWRCB that Faucet C identified as having high levels of lead at 5.9 ppb.

The faucet/outlet was located in the school office, labeled as Room 7. The director, told LPA that the faucet was immediately turned off and placed out of service. The entire sink and faucet has been removed as of April 22, 2024.

Interview with Director revealed that the faucet and drinking fountain were not in use by staff or children for drinking or food preparation. The children are provided bottled water for outside consumption and when indoors children use the water fountain and faucets in the classroom for drinking.

See LIC 809D for cited deficiency in accordance with the California Code of Regulations Title 22, Division 12 written directives.

An exit interview was conducted with Elizabeth Zaragoza, Director. A copy of this report, appeal rights and a Notice of Site Visit was issued. Director reminded that the Notice of Site Visit must remain posted for 30 consecutive days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy HamiltonTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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 04/24/2024 03:24 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL
FACILITY NUMBER: 334811701

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2024
Section Cited

101700.3(b)(1)

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101700.3(b)(1) 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... (2) Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement was not met as evidenced by:
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The Director Elizabeth Zaragoza placed the water outlet out of service by removing the entire faucet and drinking fountain. The CCC is also providing bottled drinking water to children in care and utilizing faucets/drinking fountains located in classrooms. POC has been corrected
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LPA Hamilton received water testing results taken on March 19, 2024 with an Action Level Exceedance of 5.9 which is higher than the allowable limit. The faucet/drinking fountain was located in CCC office, labeled as Room 7.

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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: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy HamiltonTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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