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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807229
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:16:41 PM

Document Has Been Signed on 04/04/2023 01:16 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SBCUSD-LYTLE CREEK PRESCHOOLFACILITY NUMBER:
364807229
ADMINISTRATOR:KELLY< LATASHIAFACILITY TYPE:
850
ADDRESS:275 S. K STREETTELEPHONE:
(909) 388-6383
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 18DATE:
04/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alma MunozTIME COMPLETED:
01:20 PM
NARRATIVE
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Due to required lead testing requirements, Licensing Program Analyst (LPA), Justin Giese 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, Alma Munoz 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 C (6.9ppb) and Outlet D (9.5ppb) which were identified as an outdoor drinking fountain bubblers, located on the playground. Additionally outlet E (10ppb) was identified as an outdoor water bottle fill station which is attached to the same fixtures as outlets C and D.

LPA observed and obtained photos of required signage posted at the outlets C, D and E for cessation of use.LPA was informed the preschool children bring their own personal water bottles to school each day. If a child forgets their water bottle or needs a refill, facility staff utilize bottled water stored within the classroom. In addition to bottled water, The facility has an additional drinking fountain available in the classroom. LPA was informed outlets C,D and E will be serviced/repared and retested for lead exceedances. Additionally, LPA observed notification of lead results posted at the facility entry.

Due to water outlets C,D, and E testing above approved lead levels, a deficiency has been cited. See LIC809D for Type B Deficiency.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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: SBCUSD-LYTLE CREEK PRESCHOOL
FACILITY NUMBER: 364807229
VISIT DATE: 04/04/2023
NARRATIVE
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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, Alma Munoz 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: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2023 01:16 PM - It Cannot Be Edited


Created By: Justin Giese On 04/04/2023 at 12:50 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SBCUSD-LYTLE CREEK PRESCHOOL
FACILITY NUMBER: 364807229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2023
Section Cited
CCR
101700.3(b)(1)

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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:
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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. Facility will notify CDSS with completion within 30 days.
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Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlets C (6.9ppb) D (9.5ppb) and E (7.1ppb)


This is a potential health and safety risk to persons in care.
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Additionaly, Facility will submit the following documents to LPA by POC date:

LIC9275: External Water Sampler Self Certification Form
LIC9276:Child Care Center Sampling Checklist Form
LIC999 (sketch or facility map w/ labeled outlets)
HSC

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Justin Giese
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
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