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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405654
Report Date: 11/29/2023
Date Signed: 11/29/2023 03:50:10 PM


Document Has Been Signed on 11/29/2023 03:50 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:PATTY'S PINOLE CHILD CAREFACILITY NUMBER:
073405654
ADMINISTRATOR:SALINAS, PATTYFACILITY TYPE:
840
ADDRESS:1224 PINOLE VALLEY RD.TELEPHONE:
(510) 776-9631
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:45CENSUS: 1DATE:
11/29/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Roberto SalinasTIME COMPLETED:
04:00 PM
NARRATIVE
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On 11/29/2023 at 1:45 PM Licensing Program Analyst (LPA) A. Curry conducted an unannounced case management inspection to follow up regarding lead testing at the facility. LPA met with Director, Roberto Salinas to explain the purpose of today's inspection. The licensee did not test its drinking water for lead contamination or request a waiver prior to January 1, 2023 (See 809D). The director indicated the children only drink water from purchased water jugs. The director was advised to submit a written waiver request to waive the lead testing requirements.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Roberto Salinas.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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 11/29/2023 03:50 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: PATTY'S PINOLE CHILD CARE
FACILITY NUMBER: 073405654

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
HSC
1597.16(a)(1)

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A licensed child day care center... constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years...
This requirement is not met as evidence by:
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The director indicated the facility only provides water jugs to children.

By 12/29/2023 the director will submit a written waiver request along with any supporting documentation.
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Based on record review and interview the facility did not comply with the section cited above by ensuring the written waiver request was submitted or the drinking water was tested prior to 01/01/2023, which poses a potential risk to the health and safety of 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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2