334801127-9-29-2022-09-CC-GCAO-CJQNA4-20220929101656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334801127
Report Date: 09/29/2022
Date Signed: 09/29/2022 10:17:03 AM

Document Has Been Signed on 09/29/2022 10:17 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:	LA PETITE ACADEMY		FACILITY NUMBER:	334801127
ADMINISTRATOR:	KELLIE BARELA		FACILITY TYPE:	850
ADDRESS:	6212 CLAY STREET		TELEPHONE:	(951) 681-3783
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY: 114	TOTAL ENROLLED CHILDREN: 114	CENSUS: 46	DATE:	09/29/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Kellie Barela		TIME COMPLETED:	08:30 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 Licensee/Director, Kellie Barela 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 Y (10.9 ppb). Outlet Y is located outdoors in the preschool playground area and LPA observed non use signage posted.
Facility implemented the following plan of action until formal remediation can be completed on water outlets: Covered water outlets, posted signage for non use and completed repair and replacement of parts for outlet Y. Facility is currently in process for retesting. LPA observed notification of lead results posted at the facility: front lobby reception.

Photos also obtained of additional source for access to water: Facility is using sports jugs and disposable cups for outdoor activity and has been since pandemic began. Due to facility water outlets testing above approved lead levels, a deficiency has been cited. See LIC809D. Additionally, the following resources were discussed and provided from PIN 21-21-CCP dated July 28, 2021:

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: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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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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: LA PETITE ACADEMY	FACILITY NUMBER: 334801127
	VISIT DATE: 09/29/2022

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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 Kellie Barela Director 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: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/29/2022 10:17 AM - It Cannot Be Edited

Created By: Giselle Carbullido On 09/29/2022 at 08:22 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: LA PETITE ACADEMY	FACILITY NUMBER: 334801127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2022 Section Cited CCR 101700.3(b)(1)	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers 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	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 : Y (10.9 ppb). 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 by POC due date: 10/18/22. Facility is scheduled for retest 10/10/22 and 10/11/22.
	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:

Gilbert Sena

LICENSING EVALUATOR NAME:

Giselle Carbullido

LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

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