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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416767
Report Date: 01/23/2023
Date Signed: 01/23/2023 03:27:47 PM


Document Has Been Signed on 01/23/2023 03:27 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:HARVEST CHRISTIAN PRESCHOOL/DAYCAREFACILITY NUMBER:
013416767
ADMINISTRATOR:DISLA DE PEREZ, JUANAFACILITY TYPE:
850
ADDRESS:4360 HANSEN AVENUETELEPHONE:
(510) 713-8748
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:98CENSUS: 21DATE:
01/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Juana Disal de PerezTIME COMPLETED:
03:30 PM
NARRATIVE
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On January 23, 2023 at approximately 2:10pm Licensing Program Analyst (LPA) R. Haderer arrived for a meeting with site director Juana Disla De Perez to review the results of the recent lead testing. There were 21 children in care and 3 fingerprint and associated staff present. The center is in ratio today.

On December 28, 2022 a lead test sample was drawn for 10 water locations in the facility. Lab results analyzed found that locations A in classroom 2 and C in classroom 3 showed lead levels to be 10.9ppb and 6.5ppb (respectively). Values greater than 5.5 ppb is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction. The other 8 locations tested were less than 5.5ppb and/or ND - non-detected.

The faucets A and C have not been in use, both classrooms (2 and 3) have not been used by children since prior to Covid. Also, children bring their own bottled water from home and if needed, they are provided with Britta filtered water. The facility does not prepare or cook food.

Upon arrival to review the test results, LPA viewed a plan of correction and the lead testing results posted in a public area. All parents have been informed of the test results and received a copy of the plan of action.

In addition to the above, a Type B deficiency and plan of correction was documented and issued today, see LIC809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site director Juana Disla da Perez.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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 01/23/2023 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: HARVEST CHRISTIAN PRESCHOOL/DAYCARE
FACILITY NUMBER: 013416767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited

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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.
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A Plan of Correction has already been issued by the facility, publically posted and issued to parents of the children in care. The plan calls for taking the affected faucets out of use and placing a "Do not use" sign on them until new faucets are ordered to replace the existing ones.
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Based on lead testing results, 2 of 10 faucets tested have lead levels exceeding 5.5ppb which poses poses 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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
LIC809 (FAS) - (06/04)
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