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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561711699
Report Date: 08/17/2023
Date Signed: 08/17/2023 02:34:19 PM


Document Has Been Signed on 08/17/2023 02:34 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CROSS ROADS CHILDREN'S CENTERFACILITY NUMBER:
561711699
ADMINISTRATOR:MICHELLE GORDONFACILITY TYPE:
850
ADDRESS:2372 ERRINGER ROADTELEPHONE:
(805) 526-2887
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:120CENSUS: 45DATE:
08/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Michelle GordonTIME COMPLETED:
03:00 PM
NARRATIVE
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On August 17, 2023 at 12:15 PM, Licensing Program Analyst (LPA) Laura Villanueva conducted an unannounced Case Management-Lead Testing/Exceedance inspection to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by Division of Drinking Water (DDW). LPA met with facility Director, Michelle Gordon and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. LPA observed a total of 45 children under the care and supervision of 11 staff.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five (5) years after the date of the first test. If the water testing results indicate that the facility has an ALE, an immediate response shall be required pursuant to section 101704, which may include remediation.

The Regional Office received an ALE for 6 water outlets in this facility. The Center was left a voicemail by LPA Daniel Venegas detailing lead test results. LPA advised Director that location (A) had an ALE of 6.6 ppb, (C) 6.4 ppb, (D) 5.8 ppb, (G) 16 ppb, (H) 6.5 ppb, amd (I) 6.4 ppb. Director advised all locations have been secured preventing children/staff from having access.

During today’s inspection, LPA toured the entire facility and inspected the outlets in question. LPA observed that the 6 outlets were secured with tape or faucet turned around. Director contacted a plumber from Highsmith and Daughters Plumbing Inc. to replace faucets. Plumber asked Director to buy faucets and then contact to schedule a date to replace them.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CROSS ROADS CHILDREN'S CENTER
FACILITY NUMBER: 561711699
VISIT DATE: 08/17/2023
NARRATIVE
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LPA advised the testing report must be posted and parents/authorized representative informed of the ALE.

LPA provided a copy of PUB 515 and discussed the need for the Center to share this with families, discussed a plan of correction with the director and informed director the Plan of Correction for lead exceedances must include notification of parents and information about what has been done (their current response, such as water fixture put out of use, and bottled water provided) and remediation plans for all water outlets. LPA informed Director that parents must acknowledge receipt of licensing report and POC.

LPA's shared the following resources quick references:

Quick references:
· PIN 22-06-CCP - Lead Testing in Child Care Centers – Frequently Asked Questions
· PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370

A type B deficiency is being cited today. See attached 809D.

Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to Director.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 08/17/2023 02:34 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CROSS ROADS CHILDREN'S CENTER
FACILITY NUMBER: 561711699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/17/2023
Section Cited

101700.3

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01700.3 California Lead Action Level at Child Care Centers
(b) Testing results with fractional ppb readings of 0.5 ppb or greater ... the Action Level. (1) A result with values of 5.5 ppb ... shall be deemed an Action Level Exceedance.
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Facility has taken the following steps: the 6 faucets have been made inaccessible, and will notify parental notification of the water testing results, and are reviewing options to correct the ALE. Facility has until 09/17/23 tto correct the deficiencies or have a reasonable plan to correct them and notify CCL.
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This requirement is not met as evidenced by:
Facility conducted water lead testing and had 6 outlets exceeded the action level exceedance per regulations. This poses a potential risk to the health and safety of the children in care.
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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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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