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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109432
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:15:56 AM


Document Has Been Signed on 02/14/2023 11:15 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:SANTA ROSA JUNIOR COLLEGE CHILDREN'S CENTERFACILITY NUMBER:
490109432
ADMINISTRATOR:ROSENBERG, TINAFACILITY TYPE:
850
ADDRESS:1501 MENDOCINO AVENUETELEPHONE:
(707) 527-4224
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:112CENSUS: 41DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Tina RosenbergTIME COMPLETED:
11:30 AM
NARRATIVE
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On 02/14/23, Licensing Program Analyst (LPA), Amy Strother made a case management inspection and met with Site Supervisor, Tina Rosenberg (D1). 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 water faucets tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: sample site "BB" tested at 7.3 ppb, "C" tested at 9.7 ppb, "F" tested at 21 ppb, "H" tested at 21 ppb, and "X" tested at 9.2 ppb (sample site "EE" is listed on both this facility license number and the infant license #490108941 and will be addressed under the infant license). D1 stated that all faucets are sinks the teachers use in the classrooms. All other sources of water tested for this facility tested below the allowable level of 5.0 ppb.

LPA obtained the following documents from D1 via email on 12/20/22; External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999). On 01/26/23 D1 emailed LPA a zip file containing photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999) as required and stated that all faucets with lead exceedances have been made inaccessible.

During today’s visit, LPA verified that the test results were posted and that faucets, “BB”, “C”, “F”, “H” and “X” have been made inaccessible to children in care. D1 stated that the faucets were replaced earlier this morning, 02/14/23, will be in the process of being flushed and will be retested on 03/10/23. D1 stated that children in care are receiving drinking water both indoors and outdoors from either reusable or disposable cups refilled with water from sinks that meet the requirements.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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 the Site Supervisor, Tina Rosenberg.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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Document Has Been Signed on 02/14/2023 11:15 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: SANTA ROSA JUNIOR COLLEGE CHILDREN'S CENTER
FACILITY NUMBER: 490109432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
Section Cited

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101700.3(b)(1) 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:
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LPA observed that the facility has temporarily removed the affected faucets “BB”, “C”, “F”, “H” and “X” from service by way of a bag over each faucet. D1 stated that the facility has replaced the faucets, will be flushing the faucets, with a plan to retest, submitting results to LPA at amy.strother@dss.ca.gov by 03/16/23.
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Based on record review, the facility had five faucets (site “BB” at 7.3 pbb, site “C” at 9.7 pbb, site “F” at 21 ppb, site “H” at 21 ppb, and “X” at 9.2 ppb) that exceeded the allowable levels of lead in the water. This is a potential health and safety risk to children in care.
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D1 stated children in care are receiving drinking water from either reusable or disposable cups that are filled with water from sinks that meet the requirements and that families have been notified of the plans for remediation.

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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