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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 081303066
Report Date: 10/05/2022
Date Signed: 10/05/2022 10:50:25 AM

Document Has Been Signed on 10/05/2022 10:50 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HEAD START - CRESCENT CITYFACILITY NUMBER:
081303066
ADMINISTRATOR:HAFLEY, GAYFACILITY TYPE:
850
ADDRESS:475 7TH STREETTELEPHONE:
(707) 464-1224
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY: 24TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
10/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gay HafleyTIME COMPLETED:
10:45 AM
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On 10/05/2022 at 8:30 AM, Licensing Program Analyst (LPA) Kiriko Lynch made a case management inspection and met with facility representative. 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 fixtures tested above the allowable level (5.5 ppb) of lead in the water:

Crescent City Head Start Program –
Fixture “475-C” – children's drinking fountain (located in currently non-licensed room), 5.6 ppb

The staff have made the fixtures inaccessible by: Facility representative stated the drinking fountain is currently located in an non-licensed room next to the licensed facility, and has not been utilized by facility children. She stated the fixture was also turned off and will replace the fixture as well. LPA noted that facility also stated this drinking fountain fixture was tested due to lead tester’s discretion, and not mandated by the regulations. No deficiencies cited during today's visit due to fixture is not located at a licensed facility. Exit interview conducted and report was reviewed with the facility representative Gay Hafley.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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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