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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455403785
Report Date: 10/26/2022
Date Signed: 10/26/2022 01:21:44 PM

Document Has Been Signed on 10/26/2022 01:21 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SHASTA HEAD START - BIRCHWOODFACILITY NUMBER:
455403785
ADMINISTRATOR:ST AMANT, ANDREAFACILITY TYPE:
850
ADDRESS:3211 CHURN CREEK ROADTELEPHONE:
(530) 221-1199
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
10/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Tayann Mulford, Lead TeacherTIME COMPLETED:
11:30 AM
NARRATIVE
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On 10/26/22 at 9:40am, Licensing Program Analyst (LPA) N. Cunningham made a case management inspection and met with T. Mulford. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb or greater) of lead in the water:

Faucet “I” – playground drinking fountain, 7.3ppb

The facility has made the faucet inaccessible by taping a bag over the the drinking fountain. The facility representative stated they believe the facility plans to permanently remove the faucet. Children in care are receiving drinking water from water pitcher and cups.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with facility representative, T. Mulford.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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Document Has Been Signed on 10/26/2022 01:21 PM - It Cannot Be Edited


Created By: Nicolette Cunningham On 10/26/2022 at 10:12 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: SHASTA HEAD START - BIRCHWOOD
FACILITY NUMBER: 455403785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2022
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers - A result with values
of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement
was not met as evidenced by:
Based on record review, the facility had one faucet(s) with lead test results at or
exceeding 5.5 ppb of lead in the water. This is a potential health and safety risk to
children in care.
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The site supervisor made the faucet temporarily inaccessible by taping a bag on the playground drinking fountain. Facility management plans to permanently remove the faucet. Photos of the removed faucet will be sent by 11/10/22.
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nicolette.cunningham@dss.ca.gov
Fax: 530-521-5235

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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:Erin Virrueta
LICENSING EVALUATOR NAME:Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022


LIC809 (FAS) - (06/04)
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