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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840528
Report Date: 12/07/2022
Date Signed: 12/07/2022 01:14:05 PM


Document Has Been Signed on 12/07/2022 01:14 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:LEUSD WILLIAM COLLIER PRESCHOOLFACILITY NUMBER:
334840528
ADMINISTRATOR:STEVE BEHARFACILITY TYPE:
850
ADDRESS:20150 MAYHALL DRIVETELEPHONE:
(951) 253-7630
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:24CENSUS: 21DATE:
12/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rachel Forkey and Sarah YatesTIME COMPLETED:
01:30 PM
NARRATIVE
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 On December 7, 2022 at 12:30 PM, Licensing Program Analyst (LPA) Andrea Taylor, conducted a Case Management visit in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Taylor met with Rachel Forkey, Teacher who was informed of the reason for the visit.

Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing.
observed the sink/faucet identified as having high levels of lead.

The sink is located in the school kitchen. The Administrator Steve Behar told LPA that the sink was immediately turned off and placed out of service and the faucet has been replaced.
The school district had all faucets tested at each location.

Interviews with staff revealed the kitchen sink is used for the kitchen staff hand washing only.


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

An exit interview was conducted with teacher. A copy of this report, appeal rights and a Notice of Site Visit was issued.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
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 12/07/2022 01:14 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: LEUSD WILLIAM COLLIER PRESCHOOL
FACILITY NUMBER: 334840528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/09/2023
Section Cited

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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 evidendence by:
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The faucet has been replaced and remains out of service until it is retested.



The re-test result will be submitted to:
Pauline.Beschorner.@dss.ca.gov
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Water testing results taken on 11/15/22.
The faucet in the kitchen tested higher for lead than the allowed limit. This faucet is used for hand washing only
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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: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
LIC809 (FAS) - (06/04)
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