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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407680
Report Date: 02/07/2023
Date Signed: 02/07/2023 12:12:58 PM

Document Has Been Signed on 02/07/2023 12:12 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SCOE - HAPPY VALLEY STATE PRESCHOOLFACILITY NUMBER:
455407680
ADMINISTRATOR:GROVES, BRANDYFACILITY TYPE:
850
ADDRESS:16300 CLOVERDALE ROADTELEPHONE:
(530) 357-2139
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
02/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Adrianne MartinTIME COMPLETED:
12:20 PM
NARRATIVE
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On 2/7/23 at 11:46am, Licensing Program Analyst (LPA) Mendez and LPA DiGenova made a case management inspection and met with facility representative Adrianne Martin. 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) of lead in the water:

Faucet “D” – staff drinking fountain, 13ppb

The staff have made the faucet inaccessible by permanently removing the water outlet. Staff bring their own water and children have access to a drinking fountain.

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 the facility representative Adrianne Martin.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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Document Has Been Signed on 02/07/2023 12:12 PM - It Cannot Be Edited


Created By: Bianca Mendez On 02/07/2023 at 11:55 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: SCOE - HAPPY VALLEY STATE PRESCHOOL
FACILITY NUMBER: 455407680

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/07/2023
Section Cited
HSC
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:

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Facility representative removed water outlet and posted a sign that water outlet is out of service.
Water outlet is permanently removed.
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Based on record review, the facility had D 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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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:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
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