<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455404765
Report Date: 11/02/2022
Date Signed: 11/03/2022 03:44:28 PM


Document Has Been Signed on 11/03/2022 03:44 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:SHASTA HEAD START - GATEWAYFACILITY NUMBER:
455404765
ADMINISTRATOR:WEDDING, ANNAFACILITY TYPE:
830
ADDRESS:17760 SHASTA DAM BLVD.TELEPHONE:
(530) 275-8913
CITY:SHASTA LAKE CITYSTATE: CAZIP CODE:
96019
CAPACITY:16CENSUS: 7DATE:
11/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Anna Wedding, Site SupervisorTIME COMPLETED:
04:00 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
On 10/26/22 at 9:40am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with A. Wedding. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb or greater) of lead in the water:

Faucet “I” – classroom faucet, 14ppb

The facility has made the faucet inaccessible by taping a bag over the the faucet. The facility representative stated they believe the facility plans to permanently remove the faucet. Children in care are receiving drinking water from another faucet.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor, A. Wedding.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 521-5235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/03/2022 03:44 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: SHASTA HEAD START - GATEWAY
FACILITY NUMBER: 455404765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2022
Section Cited

1
2
3
4
5
6
7
California Lead Action Level at Child Care Centers - A result with values
of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement
was not met as evidenced by:
Based on record review, the facility had one faucet(s) with lead test results at or
exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to
children in care.

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 521-5235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2