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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210544
Report Date: 05/27/2022
Date Signed: 05/27/2022 02:43:01 PM

Document Has Been Signed on 05/27/2022 02:43 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ARROYO GRANDE UNITED METHODIST CHILDREN'S CENTERFACILITY NUMBER:
406210544
ADMINISTRATOR:MADDY QUAGLINOFACILITY TYPE:
850
ADDRESS:275 N. HALCYON RD.TELEPHONE:
(805) 481-2223
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 12DATE:
05/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Maddy QuaglinoTIME COMPLETED:
02:58 PM
NARRATIVE
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On May 27, 2022 at 12:55 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by WWD. LPA met with facility Director, Maddy Quaglino and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 12 children in care at the time of the inspection.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five (5) years after the date of the first test. If the water testing results indicate that the facility has an ALE, an immediate response shall be required pursuant to section 101704, which may include remediation.

The Regional Office received an ALE for two (2) different water outlets in this facility. The Center was notified by LPA Pedroza of the results on May 27, 2022 by phone. LPA received a response from director stating they have not received the testing results, but the center has taken the following steps as a Plan of Correction (POC): Both outlets have been shutoff for the past two (2) years and labeled to not be used, both outlets were taped off preventing use, and parental notification of the children in classroom room 112 of the water testing results. Classroom 114 has been closed over two years and is only used for storage. Children do not have access to the classroom. The testing report will be posted when received. Director advised LPA that they contacted the Arroyo Grand United Methodist church where the center is located on to advise of the ALE. The church is looking into options to correct ALEs.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARROYO GRANDE UNITED METHODIST CHILDREN'S CENTER
FACILITY NUMBER: 406210544
VISIT DATE: 05/27/2022
NARRATIVE
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 During today’s inspection, LPA toured the entire facility and inspected the outlets in question.LPA observed both outlets were labeled, taped off, and posted to not use. Director stated since the Covid-19 outbreak started, the facility has not used the facility outlets for drinking water. Director advised LPA that the outlets were only turned on to conduct the Lead test and immediately turned off after the test was completed. Each classroom is provided bottled water for the children and staff to use for drinking inside and outside.

LPAs provided a copy of PUB 515 and discussed the need for the Center to share this with families, discussed a plan of correction with the director and informed director the Plan of Correction for lead exceedances must include notification of parents and information about what has been done (their current response, such as water fixture put out of use, and bottled water provided) and remediation plans for all water outlets. LPA informed Director that parents must acknowledge receipt of licensing report and POC.

LPA shared the following resources quick references:

Quick references:
· PIN 22-06-CCP - Lead Testing in Child Care Centers – Frequently Asked Questions
· PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370
· External Water Sampler Self-Certification Form (LIC 9275)
· Child Care Center Sampling Checklist Form (LIC 9276)
· CDSS Lead Toxicity Prevention and Water Testing Information page
· Resources listed on Sacramento State University, Office of Water Program website
· CCLD website: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

A type B deficiency is being cited today. See attached 809D.

Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to Director.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
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Document Has Been Signed on 05/27/2022 02:43 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 05/27/2022 at 01:54 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ARROYO GRANDE UNITED METHODIST CHILDREN'S CENTER
FACILITY NUMBER: 406210544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by
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Facility has taken the following steps: Shutoff and labeled the two (2) outlets, parental notification of the water testing results, and are reviewing options to correct the ALE. Facility is providing bottled water for children and staff.
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Facility conducted water lead testing and two (2) outlets exceeded the action level exceedance per regulations. This poses a potential risk to the health and safety of 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:Maria Mueller
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022


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