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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125400415
Report Date: 06/30/2022
Date Signed: 06/30/2022 04:21:24 PM

Document Has Been Signed on 06/30/2022 04:21 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:HEAD START - REDWAY/GARBERVILLEFACILITY NUMBER:
125400415
ADMINISTRATOR:DOUGLAS, ROSEFACILITY TYPE:
850
ADDRESS:334 EMPIRE AVETELEPHONE:
(707) 923-4691
CITY:REDWAYSTATE: CAZIP CODE:
95560
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
06/30/2022
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Naomi Faulkner/Abraxas LaytonTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/30/2022 at 9:00 AM, Licensing Program Analyst (LPA) Kiriko Lynch made a collateral inspection and met with Naomi Faulkner and Abraxas Layton. 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:

Redway/Garberville Head Start Program –
Fixture “G” – adult restroom hand-washing sink, 9.8 ppb
Fixture “H” – exterior children’s drinking fountain, 23 ppb

The staff have made the fixtures inaccessible by: Facility staff have wrapped the drinking fountain in plastic and tape. Facility representative stated the fountain was shut off and has not been used since the start of the Covid-19 pandemic. Facility representative stated the fountain was removed and replaced on 06/10/2022 and was retested on 06/28/2022 and is awaiting results. Children in care were receiving drinking water from dispensers and disposable cups filled with water from the facility kitchen sink, and program has currently closed for the summer until 09/06/2022. Facility representative stated the adult restroom handwashing faucet was replaced and a permanent sign will be posted at the fixture for handwashing only, no potable water available. LPA noted that facility stated this adult restroom fixture was tested due to lead tester’s discretion, and not mandated by the regulations.

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 facility representatives Naomi Faulkner and Abraxas Layton.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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 06/30/2022 04:21 PM - It Cannot Be Edited


Created By: Kiriko Lynch On 06/30/2022 at 12:36 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: HEAD START - REDWAY/GARBERVILLE
FACILITY NUMBER: 125400415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/01/2022
Section Cited
CCR
101238(a)

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Buildings and Grounds - 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:
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The licensee agrees to submit/resubmit an LIC 9275 and LIC 9276 by POC due date. The licensee has made the fixture(s) inaccessible until retested/fixed or replaced, or applicable fixture(s) have been already retested/fixed and replaced or signage posted.
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Based on record review, the facility had faucet(s) 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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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:Erin Virrueta
LICENSING EVALUATOR NAME:Kiriko Lynch
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022


LIC809 (FAS) - (06/04)
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