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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605690
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:27:26 PM

Document Has Been Signed on 04/21/2023 03:27 PM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ENCINA EARLY HEAD STARTFACILITY NUMBER:
343605690
ADMINISTRATOR:MILLER, GLENNISFACILITY TYPE:
830
ADDRESS:1400 BELL STREETTELEPHONE:
(916) 971-5840
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 37TOTAL ENROLLED CHILDREN: 37CENSUS: 1DATE:
04/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Tina GehrerTIME COMPLETED:
03:30 PM
NARRATIVE
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On April 21, 2023, at approximately 2:45 PM Licensing Program Analyst (LPA) Josiah Gathing met with Facility Representative Tina Gehrer to conduct an unannounced case management inspection. During today's inspection there was 1 toddler child being supervised by 2 teachers. The purpose of today's inspection was to create a plan of correction following a report of lead exceedance in one of the facility outlets.

On January 4, 2023, the facility tested water samples for lead. One water outlet sampled indicated an Action Level Exceedance (ALE). This outlet is marked H on the facility sketch provided by the center. Outlet H correlates to a sink located in the U2 class room. On February 6, 2023 the facility was notified that water levels were in exceedance of 5 parts per billion in outlet H.

A deficiency is cited on the following LIC809-D and the plan of correction was reviewed with the Facility Representative, Tina Gehrer. A copy of this report and appeal rights were provided to the Facility Representative.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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Document Has Been Signed on 04/21/2023 03:27 PM - It Cannot Be Edited


Created By: Josiah Gathing On 04/21/2023 at 03:15 PM
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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ENCINA EARLY HEAD START
FACILITY NUMBER: 343605690

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3 ...Lead Action Level... (b) ...(1) If testing indicates an Action Level Exceedance at any water outlet, the water... is deemed not safe to drink and an immediate response... shall be required.
This requirement was not met as evidenced by:
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The water outlet in exceedance was replaced prior to today's inspection. Facility will provide proof to LPA that re-testing has been scheduled.
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Based on record review the facility did not comply with the above regulation as the lead action level was exceeded in one water outlet, which poses Health, Safety, or Personal Rights risk to persons 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Josiah Gathing
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023


LIC809 (FAS) - (06/04)
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