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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402249
Report Date: 12/14/2022
Date Signed: 12/14/2022 10:23:13 AM


Document Has Been Signed on 12/14/2022 10:23 AM - 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:DORRIS-EATON SCHOOL, THEFACILITY NUMBER:
073402249
ADMINISTRATOR:O'CONNEL, RACHELFACILITY TYPE:
850
ADDRESS:1286 STONE VALLEY ROADTELEPHONE:
(925) 837-7240
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:90CENSUS: 55DATE:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rachel O'ConnelTIME COMPLETED:
10:30 AM
NARRATIVE
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On 12/14/22 Licensing Program Analyst (LPA) Monica Mathur met with Director, Rachel O'Connell to conduct a Case Management inspection for the Lead Testing results at Center.

LPA conducted an inspection and toured the premises with Director. It was indicated there was at least one outlet that exceeded the Action Level established by the State for exposure. Faucet is in the TK2 restroom located in the upper building. It was being used for hand washing and filling water bottles for drinking. Director states faucet has been replaced and sink/faucet was observed taped off and out of use. Re-testing is scheduled in end January.

This poses/posed a potential risk to health and safety of children in care. Deficiency is cited from the California Code of Regulations, Title 22 (see page 809D). Facility has submitted the required documentation for lead testing and steps taken to remediate.

Exit interview conducted and report was reviewed with Director, Rachel O'Connell. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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 12/14/2022 10:23 AM - 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: DORRIS-EATON SCHOOL, THE
FACILITY NUMBER: 073402249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited

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101238 Buildings and Grounds (a)The childcare 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 ceased use of the faucet, replaced and awating re-testing. Director has submitted a written plan on steps taken to remediate. Deficiency was cleared during inspection and Letter of Clearance provided.
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Based on Lead Testing Sample results the facility has one (1) water faucet with lead exposure. This posed a potential risk to Health and Safety of persons 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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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