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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561711931
Report Date: 09/28/2022
Date Signed: 09/28/2022 11:59:19 AM

Document Has Been Signed on 09/28/2022 11:59 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VUSD - JUMPSTART (MONTALVO)FACILITY NUMBER:
561711931
ADMINISTRATOR:LORETTA GALAVIZFACILITY TYPE:
850
ADDRESS:2050 GRAND AVENUETELEPHONE:
(805) 289-1872
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
09/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Ruth ValenciaTIME COMPLETED:
12:20 PM
NARRATIVE
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On September 28, 2022 at 10:53 AM, Licensing Program Analyst (LPA) Rona Chavez conducted an unannounced Case Management inspection to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by Division of Drinking Water (DDW). LPA met with Site Supervisor, Ruth Valencia and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 15 children in care at the time of the inspection.

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 one (1) water outlet in this facility. The Center was notified by LPA Chavez of the results on September 09,2022 by email. Director of Risk Management Eric Reynold's sent in report on 6/8/2022. Mr. Reynold's reported the water had been shut off to the outlet and secured to prevent children/staff from having access.

During today’s inspection, LPA's toured the entire facility and inspected the outlet in question. LPA observed that the one (1) outlet was back in use. Per email by Mr. Eric Reynolds faucet was replaced and retested with a ALE result of 2.0 passing. Site Supervisor advised that the outlets have been closed since Covid-19 began. Prior to Covid-19 the outlets were used for drinking water.

Continued on 809-C
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: VUSD - JUMPSTART (MONTALVO)
FACILITY NUMBER: 561711931
VISIT DATE: 09/28/2022
NARRATIVE
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LPA's advised the testing report must be posted and parents/authorized representative informed of the ALE.

LPA's 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 supervisor and informed 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's 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 Site Supervisor, Ruth Valencia . Appeal rights were provided to Director.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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Document Has Been Signed on 09/28/2022 11:59 AM - It Cannot Be Edited


Created By: Rona Chavez On 09/28/2022 at 11:24 AM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VUSD - JUMPSTART (MONTALVO)
FACILITY NUMBER: 561711931

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2022
Section Cited

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101700.3 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.
This requirement is not met as evidenced by:
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Facility conducted water lead testing and had one (1) outlet exceed 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:Ana Tolentino
LICENSING EVALUATOR NAME:Rona Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


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