<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910780
Report Date: 07/01/2024
Date Signed: 07/01/2024 10:42:24 AM

Document Has Been Signed on 07/01/2024 10:42 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JUSD/WEST ELEMENTARY PRESCHOOL/HEADSTARTFACILITY NUMBER:
330910780
ADMINISTRATOR/
DIRECTOR:		ROSA SANTOS-LEE, KATRINA BFACILITY TYPE:
850
ADDRESS:5671 42ND STTELEPHONE:
(951) 222-7850
CITY:JURUPASTATE: CAZIP CODE:
92509
CAPACITY: 46TOTAL ENROLLED CHILDREN: 34CENSUS: 0DATE:
07/01/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Katrina Brooks, Area Director TIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Due to required lead testing requirements, Licensing Program Analyst (LPA), Susan Brewer conducted a Case Management inspection based on lead testing results received on the facility. LPA S. Brewer toured the facility, took census and met with Area Director Katrina Brooks, to further discuss lead results received 10/14/2022 and measures taken for remediation of lead exceedances.

During the inspection, LPA toured and obtained photos of the following water outlets identified with lead exceedances: Outlet A-Rm 5 fountain 12.0 ppb, E 6.4 ppb & F 130 ppm located in the work room kitchenette area. LPA observed photos of required signage posted at outlets for cessation of use.

Facility implemented the following plan of action until formal remediation can be completed on water outlets: Covered water outlets and posted required signage for nonuse.. The facility submitted a work order for repair in the early spring of 2023 for retesting scheduled in March 04, 2023. LPA observed notification of lead results posted at the facility.

Photos also obtained of additional source for access to water: Facility has access to additional water resources. The facility used bottled water, fillable water bottles and disposable cups and use of other outlets that passed lead testing.

Due to facility water outlets testing above approved lead levels, a Type B deficiency has been cited.


See LIC809D. No civil penalties issued.

An exit interview was conducted, and appeal rights discussed. LPA S. Brewer provided Area Director Katrina Brooks with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for three years.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/01/2024 10:42 AM - It Cannot Be Edited


Created By: Susan Brewer On 07/01/2024 at 09:48 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD/WEST ELEMENTARY PRESCHOOL/HEADSTART
FACILITY NUMBER: 330910780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
101700.3(b)(1)

1
2
3
4
5
6
7
101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:
1
2
3
4
5
6
7
POC: Facility will implement corrective action pursuant to section CCR 101704 for immediate cessation of outlets testing with action level exceedance until it is replaced and retested pursuant to section CCR 101705 and returns a result at or below the Acton level.
8
9
10
11
12
13
14
Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlets A - 12.0 ppb in room 5, E - 6.4 ppb & F 130 ppb in kitchenette/workroom. This is a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
Facility will notify CDSS with completion within 30 days.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2