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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422016
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:41:14 PM


Document Has Been Signed on 05/24/2023 12:41 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:LA PLAZITA PRESCHOOL IIFACILITY NUMBER:
013422016
ADMINISTRATOR:YALIN MILLER MORALESFACILITY TYPE:
850
ADDRESS:3625 MACARTHUR BLVDTELEPHONE:
(510) 566-5007
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:45CENSUS: 37DATE:
05/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Etelvina LopezTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Lisa Dyer arrived at the facility to conduct an unannounced Case Management Inspection to follow up on results received regarding lead testing/exceedance. LPA met with Etelvina Lopez, director. There were 37 children and 5 staff members also present.

The facility completed the required lead testing of water outlets.

Two outlets were found to be in exceedance of the Action Level of 5 ppb. The two outlets were in bathroom. The facility took immediate action and labeled the two outlets "WATER NOT FOR DRINKING". The facility completed and submitted all required documents to Community Care Licensing and posted the test results in the facility. Facility will notify all families of the results by the end of the week. LPA inspected the two outlets and verified that signs have been placed.

See LIC 809-D for a deficiency being cited today. No other deficiencies are being cited today.

An exit interview was conducted with Etelvina Lopez and a copy of this report, Notice of Site Visit, and appeal rights were provided. Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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 05/24/2023 12:41 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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: LA PLAZITA PRESCHOOL II
FACILITY NUMBER: 013422016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
06/24/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) 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.
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The facility immediately made the two outlets “not for consumption”. Signs were placed on the units.
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This requirement has not been met as evidenced by the lead testing results received, indicating that two outlets in the facility had results in exceedance of the 5 ppb Action Level. This poses a potential risk to the children in care.
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Facility director states the outlet will only be used for hand washing. The outlets are not be used for drinking water until the Action Level is determined to be 5 ppb or below.

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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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