<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701163
Report Date: 12/06/2022
Date Signed: 12/06/2022 12:01:33 PM

Document Has Been Signed on 12/06/2022 12:01 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:TOGETHER WE GROWFACILITY NUMBER:
376701163
ADMINISTRATOR:KIMBERLY CIERZANFACILITY TYPE:
850
ADDRESS:2120 THIBODO ROADTELEPHONE:
(760) 757-6031
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 17DATE:
12/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kimberly Cierzan-DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On December 6, 2022 at 10:30 AM, Licensing Program Analyst (LPA) Andrea Taylor, conducted a Case Management visit in response to information received from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). LPA Taylor met with Kimberly Cierzan, Site Director (SD) who was informed of the reason for the visit.

Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing.

During the visit, LPA Taylor toured the facility and observed the sink faucet identified as having high levels of lead. The sink is located in the staff breakroom. The SD told LPA that the sink is not ever used and was immediately turned off and placed out of service until the plumber could come and replace the faucet.

Interviews with staff revealed the sink and faucet are not used for any reason as there is a sink and faucet next to the refrigerator which is used instead.

See LIC 809D for cited deficiency in accordance with the California Code of Regulations Title 22, Division 12.

An exit interview was conducted with SD. A copy of this report, appeal rights and a Notice of Site Visit was issued.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Andrea Taylor
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/06/2022 12:01 PM - It Cannot Be Edited


Created By: Andrea Taylor On 12/06/2022 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: TOGETHER WE GROW
FACILITY NUMBER: 376701163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2023
Section Cited
CCR
101703(b)(1)

1
2
3
4
5
6
7
Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This was not met as evidenced by:
1
2
3
4
5
6
7
The Director stated the company hired is scheduled to be out to the facility 12/7/22 to replace the sink and faucet.

The director will submit work order to LPA and after retesting the sink and faucet will submit the test results.
andrea.taylor@dss.ca.gov
8
9
10
11
12
13
14
A sample of water taken on 10/15/22 and tested for lead level by a certified water tester.
The sink and faucet identified as exceeding the allowed level is in the staff breakroom where there are two sinks and according to staff the one which tested high is not used by anyone.
8
9
10
11
12
13
14

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:Pauline Beschorner
LICENSING EVALUATOR NAME:Andrea Taylor
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2