360906560-4-4-2023-09-CC-JGIE-CQKTTE-20230404150037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360906560
Report Date: 04/04/2023
Date Signed: 04/04/2023 03:00:50 PM

Document Has Been Signed on 04/04/2023 03:00 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	SAN BERNARDINO CITY SCHOOL DIST. -ALLRED CHILD DEV		FACILITY NUMBER:	360906560
ADMINISTRATOR:	KELLY, LATASHIA		FACILITY TYPE:	850
ADDRESS:	303 S. K STREET		TELEPHONE:	(909) 388-6307
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92410
CAPACITY: 150	TOTAL ENROLLED CHILDREN: 150	CENSUS: 62	DATE:	04/04/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Deborah Johnson		TIME COMPLETED:	03:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Due to required lead testing requirements, Licensing Program Analyst (LPA), Justin Giese conducted a Case Management inspection based on lead testing results received from the facility. LPA toured the facility, took census and met with Site Supervisor, Deborah Johnson to further discuss lead results received and measures taken for remediation of lead exceedances. During the inspection, LPA toured the facility and obtained photos of the following water outlets identified with lead exceedances: Outlet H (17ppb) which is located in Green Room C3 and Outlet S (6.1ppb), which is located on the exterior of Brown Room A3. Outlet H is an in-door drinking fountain bubbler and outlet S is an outdoor drinking fountain bubbler. LPA observed and obtained photos of outlets H and S. Both outlets have been placed out of service with a red plastic lockable cap. LPA was informed the preschool children bring their own personal water bottles to school each day. If a child forgets their water bottle or needs a refill, facility staff utilize bottled water stored in the administration office. In addition to bottled water, The facility has additional drinking fountains available. LPA was informed outlets H and S will be serviced/repaired and retested for lead exceedances. Additionally, LPA observed notification of lead results posted at the facility entry. Due to water outlets H and S testing above approved lead levels, a deficiency has been cited. See LIC809D for Type B Deficiency.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN BERNARDINO CITY SCHOOL DIST. -ALLRED CHILD DEV	FACILITY NUMBER: 360906560
	VISIT DATE: 04/04/2023

NARRATIVE

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LPA was unable to collect the following documents at time of visit:

LIC9275: External Water Sampler Self Certification Form
LIC9276:Child Care Center Sampling Checklist Form
LIC999 (Facility sketch or facility map with labeled outlets tested)

Facility is asked to submit these documents to LPA on or before stated Plan of Correction date listed on LIC809D (05/04/2023)

Additionally, the following resources were discussed and provided from PIN 21-21.1- CCP dated December 28, 2022:
101700.6 Grant Funding for Qualifying Child care Centers
(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:
(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.
(2) Those that have 50 percent or more of their registered children who receive subsidized care.
(3) Those that operate only one facility.
(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.
(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

An exit interview was conducted, and appeal rights discussed. LPA provided Site Supervisor, Deborah Johnson with a copy of this report and notice of site visit, which must be posted for the next 30 days. This report must be made available to the public upon request for the next three years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/04/2023 03:00 PM - It Cannot Be Edited

Created By: Justin Giese On 04/04/2023 at 01:52 PM

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN BERNARDINO CITY SCHOOL DIST. -ALLRED CHILD DEV	FACILITY NUMBER: 360906560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/04/2023 Section Cited	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers 101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:
	8 9 10 11 12 13 14	Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlets H (17ppb) and S (6.1ppb) This is a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	Additionaly, Facility will submit the following documents to LPA by POC date: 05/04/2023 LIC9275: External Water Sampler Self Certification Form LIC9276:Child Care Center Sampling Checklist Form LIC999 (sketch or facility map w/ labeled outlets)
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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:

Gilbert Sena

LICENSING EVALUATOR NAME:

Justin Giese

LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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