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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818806
Report Date: 12/14/2022
Date Signed: 12/14/2022 10:28:46 AM

Document Has Been Signed on 12/14/2022 10:28 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RENU HOPE FOUNDATIONFACILITY NUMBER:
334818806
ADMINISTRATOR:VICKY TREVINOFACILITY TYPE:
830
ADDRESS:99085 CORVINA DRIVETELEPHONE:
(951) 845-3816
CITY:NORTH SHORESTATE: CAZIP CODE:
92254
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 14DATE:
12/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Maria CamachoTIME COMPLETED:
10:40 AM
NARRATIVE
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On 12/14/ 2022 at 08:30 am, Licensing Program Analyst (LPA) Lorena Valenzuela made an unannounced Case Management inspection, for reported Lead Exceedance at the facility’s water. LPA met with Area Child Development Specialist Maria Camacho and proceeded to tour the facility. Also present in the facility were 14 daycare children and 7 teachers/staff. Facility was within ratio and capacity. Staff members have the required background clearances.
LPA interviewed Maria Camacho and examined the faucet deemed with an Action Level Exceedance. On 11/04/2022, the facility provided the Department the facility sketch, plan of correction and signed and dated External Water Sampler Self- Certification (LIC 9275) and Child Care Sampling Checklist (LIC 9276) forms along with reports provided by the external water sampler. Parents were notified via the parent communication board and an online parent communication portal about the latest lead test results.
Based on the water sample taken on 10/25/2022, water outlet reported 5.5 ppb (parts per billion) or greater lead exceedance levels as follows:
Water faucet in kitchen, labeled letter A 57.0 ppb

All other fountains and water outlets tested within an acceptable level with no lead exceedance. The facility representative Maria Camacho states they discontinued use of the faucet located in the kitchen labeled letter A as soon as they received the lead test results.
At time of inspection LPA Valenzuela observed that the water outlet labeled letter A, had a “do not use” sign. Per Maria Camacho the faucet labeled letter A was previously being used for food preparation for the children in care and it is the only faucet/sink located in the kitchen. Maria Camacho states that drinking water is available throughout the facility via the water fountains and in water containers used by each classroom that is filled with water from faucets that did not have an lead exceedance. Per Maria Camacho the facility is currently following the flush schedule and plans to have the water re-tested.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RENU HOPE FOUNDATION
FACILITY NUMBER: 334818806
VISIT DATE: 12/14/2022
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Based on records review and information received, and current policies and procedures for the Department, the facility is being cited for having a lead exceedance in water fountain labeled letter A, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers.
See deficiency report, LIC809D for cited deficiency.
Exit interview conducted and report was reviewed with Maria Camacho, Area Child Development Specialist. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/14/2022 10:28 AM - It Cannot Be Edited


Created By: Lorena Valenzuela On 12/14/2022 at 10:03 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RENU HOPE FOUNDATION
FACILITY NUMBER: 334818806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/13/2023
Section Cited

101700.3(b)(1)

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101700.3 (b) (1) Written Directives...A result
with values of 5.5 ppb or greater shall be
deemed an Action Level Exceedance.
This requirement was not met as evidence by:
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Maria Camacho agrees to submit documentation of the upcoming water test/ resample for faucet labeled latter A. Will provide documentation to the Department by due date 01/13/2023.
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Based on records review and interviews, facility tested over the Action Level Exceedance, in one faucet in the kitchen labeled letter A, which is used for food preparation. This poses a potential health, safety, or personal rights risk to the 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:Stephanie Hudak
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022


LIC809 (FAS) - (06/04)
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