334818064-5-9-2023-09-CC-GCAO-CRNMCG-20230509092931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334818064
Report Date: 05/09/2023
Date Signed: 05/09/2023 09:29:40 AM

Document Has Been Signed on 05/09/2023 09:29 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/MAGNOLIA ELEMENTARY SCHOOL		FACILITY NUMBER:	334818064
ADMINISTRATOR:	HECTOR ALEGRIA		FACILITY TYPE:	850
ADDRESS:	3975 MAPLEWOOD PLACE		TELEPHONE:	(951) 788-7274
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 20	DATE:	05/09/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Luz Romero, Coordiantor		TIME COMPLETED:	09:40 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 B (5.5 ppb) which is located inside the classroom. LPA observed and obtained 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. Facility is currently in process for remediation prior to retesting. LPA did not observe notification of lead results posted at the facility.

Facility has access to additional water resources: Facility is bringing in store bought bottled water at this time.

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 21-21.1-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/MAGNOLIA ELEMENTARY SCHOOL	FACILITY NUMBER: 334818064
	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, Coordinator 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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Document Has Been Signed on 05/09/2023 09:29 AM - It Cannot Be Edited

Created By: Giselle Carbullido On 05/09/2023 at 09:15 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: RUSD/MAGNOLIA ELEMENTARY SCHOOL	FACILITY NUMBER: 334818064
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2023 Section Cited CCR 101700.3(b)(2)	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers:101700.3 (b)(2): Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. 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. Facility will notify CDSS with completion within 30 days.
	8 9 10 11 12 13 14	Based on records review of required lead testing, the facility had lead values of 5.0 or above on water outlet B (5.5 ppb). This is a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	Facility will post notification of lead exceedance by 5/12/23.
	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: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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