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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701392
Report Date: 11/14/2022
Date Signed: 11/14/2022 03:08:58 PM


Document Has Been Signed on 11/14/2022 03:08 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:AKA HEAD START - JACKMANFACILITY NUMBER:
376701392
ADMINISTRATOR:ANGELA CARROLLFACILITY TYPE:
850
ADDRESS:832 JACKMAN STREETTELEPHONE:
(619) 334-4444
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:64CENSUS: 18DATE:
11/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Angela CarrollTIME COMPLETED:
03:20 PM
NARRATIVE
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On 11/14/2022 at 1:45pm, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced case management inspection, for Action Level Exceedance (ALE) detected in facility's water fixture. LPA met with Director, Angela Carroll. Also present in the facility were 18 day care children and 8 teachers/staff supervising the napping children. Facility was within title 5 ratio and all staff members are associated to the facility's administrative site Aka Head Start Farragut Circle/370806089.

Per the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.



Facility provided facility sketch and required forms External Water Sampler Self-Certification LIC 9275 and Facility Sketch LIC999 to Department on 11/10/2022. LPA also obtained the copies of the Form LIC9276 Child Care Center Sampling Checklist during today's visit.

On 10/24/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 10/15/2022.



Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follow:

Sample Site F/F30 Sec Flush --Corner Hand Sink Faucet in Room 3, currently not in use

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: AKA HEAD START - JACKMAN
FACILITY NUMBER: 376701392
VISIT DATE: 11/14/2022
NARRATIVE
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Director stated that the corner sink faucet in room 3 has not been use since June of 2022 due to shortage of staff. Facility has replaced the corner sink faucet in room 3 on 10/27/2022. Director stated that the facility is scheduled to have the faucet retest on 11/21/2022. LPA advised Director to submit another LIC9276 upon completion of the retest.

Facility has the lead water testing report posted at the facility for parents to see.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

See LIC809D for type B deficiency cited.

Exit interview conducted and report was reviewed with the facility representative, Angela Carroll. A copy of PIN 21-21-CCP was provided to facility today. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/14/2022 03:08 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: AKA HEAD START - JACKMAN
FACILITY NUMBER: 376701392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

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California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., 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 is not met as evidenced by:
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Based on record review, the licensee did not comply with the directive above, as one water outlet (corner hand wasking sink outlet in room 3) out of ten outlets tested with an Action Level Exceedance (ALE). This poses a potential Health and Safety risk to children in care.
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Facility is scheduled to have the faucet retest on 11/21/2022. Facility shall submit the test result along with the LIC9276 to LPA no later than 11/30/2022.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
LIC809 (FAS) - (06/04)
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