330911337-5-9-2023-09-CC-GCAO-CRNNCQ-20230509102107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330911337
Report Date: 05/09/2023
Date Signed: 05/09/2023 10:21:13 AM

Document Has Been Signed on 05/09/2023 10:21 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	RUSD/PACHAPPA ELEMENTARY SCHOOL		FACILITY NUMBER:	330911337
ADMINISTRATOR:	ERICA SQUARE		FACILITY TYPE:	850
ADDRESS:	6200 RIVERSIDE AVENUE		TELEPHONE:	(951) 788-7355
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 18	DATE:	05/09/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Luz Romero		TIME COMPLETED:	10:30 AM

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Due to required lead testing requirements, Licensing Program Analyst (LPA), Giselle Carbullido conducted a Case Management inspection based on lead testing results received on the facility. LPA Carbullido toured the facility, took census and met with Coordinator Luz Romero to further discuss lead results received 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 E (7.7 ppb) which is a sink located in storage room next to day care classroom. LPA observed and obtained photos of required signage posted at outlets for cessation of use. Outlet E is a sink faucet not used for drinking or food preparation.

Facility implemented the following plan of action on water outlets: Covered water outlet and posted required signage for nonuse. Facility does not use outlet E for any food preparation or drinking and submitted a written statement during this visit.

Facility has access to additional water resources: indoor drinking fountain and water faucet located in the classroom. All food preparation is delivered from school district food service.

Due to facility not using outlet E for drinking or food preparation, no deficiency is cited.

Additionally, the following resources were discussed and provided from PIN 21-21.1-CCP dated December 28, 2022: 101700.6 Grant Funding for Qualifying Child care Centers
(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RUSD/PACHAPPA ELEMENTARY SCHOOL	FACILITY NUMBER: 330911337
	VISIT DATE: 05/09/2023

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(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.

(2) Those that have 50 percent or more of their registered children who receive subsidized care.

(3) Those that operate only one facility.

(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.

(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

An exit interview was conducted, and appeal rights discussed. LPA Carbullido provided to Luz Romero 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: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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