364800897-5-8-2023-09-CC-ASHA-CRMPU9-20230508113707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364800897
Report Date: 05/08/2023
Date Signed: 05/08/2023 11:37:14 AM

Document Has Been Signed on 05/08/2023 11:37 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:	FUSD/POPLAR ELEMENTARY		FACILITY NUMBER:	364800897
ADMINISTRATOR:	DARCY WHITNEY		FACILITY TYPE:	850
ADDRESS:	9937 POPLAR AVENUE		TELEPHONE:	(909) 357-5720
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 11	DATE:	05/08/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Maria Jose-Castillo, Lead Teacher		TIME COMPLETED:	11:50 AM

NARRATIVE

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Due to required lead testing requirements, Licensing Program Analyst (LPA), Aman Sharma conducted a Case Management inspection based on lead testing results received from the facility. LPA toured the facility, took census, and met with lead teacher, Maria Jose-Castillo 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 I (12ppb), which was identified as the sink in the back of the classroom.

LPA observed and obtained photos of required signs posted at the outlets for cessation of use.

Facility implemented the following plan of action until formal remediation can be completed: Facility is utilizing their own water bottles. Children have the option to bring their own water bottles, which are re-filled by filtered water. Small plastic water bottles are offered to children who did not bring their own bottles. LPA verified their functionality and observed a thermos kept in the room which is refilled with filtered water. LPA was informed by facility maintenance staff that outlet I will have fixtures replaced, the outlets will then be re-tested for exceedances at a later date. The identified water outlet has been covered and sealed with posted signs of non-use.

Facility is currently in the process of repair of fixture I. Additionally, LPA observed notification of lead results posted at the facility entry.

Due to water outlet I testing above approved lead levels, a deficiency has been cited. See LIC809D for Type B Deficiency.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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: FUSD/POPLAR ELEMENTARY	FACILITY NUMBER: 364800897
	VISIT DATE: 05/08/2023

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LPA was unable to collect the following documents at time of visit:

LIC9275: External Water Sampler Self Certification Form
LIC9276:Child Care Center Sampling Checklist Form
LIC999 (Facility sketch or facility map with labeled outlets tested)

Facility is asked to submit these documents to LPA on or before stated Plan of Correction date listed on 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:
(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 provided Lead Teacher, Maria Jose-Castillo with a copy of this report and notice of site visit, which must be posted for the next 30 days. This report must be made available to the public upon request for the next three years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/08/2023 11:37 AM - It Cannot Be Edited

Created By: Aman Sharma On 05/08/2023 at 11:22 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: FUSD/POPLAR ELEMENTARY	FACILITY NUMBER: 364800897
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/05/2023 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, removed or 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 outlet I (12ppb). 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 within 30 days.Additionaly, Facility will submit the following documents to LPA by POC date: LIC9275: External Water Sampler Self Certification, LIC9276:Child Care Center Sampling Checklist, LIC999 (sketch or facility map w/ labeled outlets)
	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:

Kimberly Williams

LICENSING EVALUATOR NAME:

Aman Sharma

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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