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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045403573
Report Date: 07/20/2022
Date Signed: 07/20/2022 02:27:10 PM

Document Has Been Signed on 07/20/2022 02:27 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:ASSOCIATED STUDENTS CHILDREN'S CENTERFACILITY NUMBER:
045403573
ADMINISTRATOR:HANSEN, JACKIEFACILITY TYPE:
830
ADDRESS:CSU CHICOTELEPHONE:
(530) 898-5865
CITY:CHICOSTATE: CAZIP CODE:
95929
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
07/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Jackie HansenTIME COMPLETED:
01:50 PM
NARRATIVE
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On 7/20/22 at 1:22pm, Licensing Program Analyst (LPA) Mendez made a case management inspection and met with Jackie Hansen. 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) of lead in the water:

Faucet “A” – kitchen sink (infant classroom) 10ppb
Faucet “B" – Kitchen sink (infant classroom) 6ppb

The staff have made the faucet inaccessible by not using the faucet. The facility representative plans to retest if possible if not then will make the faucet permanently inoperable. There are currently no children in care and children would not have access to kitchen sink. Facility representative will have filtered water provided by Mt Shasta water company for when children return back to the center.

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 the licensee Jackie Hansen.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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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Document Has Been Signed on 07/20/2022 01:48 PM - It Cannot Be Edited


Created By: Bianca Mendez On 07/20/2022 at 01:28 PM
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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: ASSOCIATED STUDENTS CHILDREN'S CENTER
FACILITY NUMBER: 045403573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2022
Section Cited
HSC
101238(a)

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The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
Based on record review, the facility had 2 faucets that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to children in care.
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The licensee agrees to submit an LIC 9275 and LIC 9276 by August 10th, 2022. The facility representaitve has made the faucets temporarily inaccessible by signs. The facility representative plans to replace and retest the faucet . Retesting documents will be submitted within 2 weeks of the completed sampling. OR The licensee agrees to permanently remove the faucet. Photos will be sent by 7/21/22.
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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:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
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