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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406638
Report Date: 01/25/2023
Date Signed: 01/25/2023 03:01:57 PM


Document Has Been Signed on 01/25/2023 03:01 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:CHILD DAY SCHOOL, LLC - ANTIOCHFACILITY NUMBER:
073406638
ADMINISTRATOR:COLETTO, KATHYFACILITY TYPE:
850
ADDRESS:112 EAST TREGALLAS ROADTELEPHONE:
(925) 754-0144
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:92CENSUS: 27DATE:
01/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kathy ColetteTIME COMPLETED:
03:20 PM
NARRATIVE
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On 01/25/23 at 1:30PM, Licensing Program Analyst (LPA) Christina Watts met with Director, Kathy Colette to conduct a Case Management inspection for the Lead Testing results at Child Day School, LLC - Antioch.

Test results indicated that there was 1 outlet which exceeded the Action Level established by the State for exposure. LPA Watts made contact with Director on 01/17/2023 and the Director stated that outlet has been removed as of 01/15/2023. LPA informed Director to submit Lead Test results with LIC 9275 and LIC 9276 along with an update facility sketch of location of outlets. Director faxed required documents to licensing.

During today's inspection, LPA observed the water fountain in room 1 and the water fountain has been permanently removed. Director stated children have their own refillable cups that is used for drinking water.

Director stated the last known used of that fountain was November 2022. Due the outlet being in use by children for drinking water, children were potentially exposed to lead which is a risk to their health and safety. Deficiency is cited on page 809D).

Due to facility permanently removing the outlet, facility will receive a clearance letter as of 01/25/2023.

Exit interview conducted and report was reviewed with the Director, Kathy Colette. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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 01/25/2023 03:01 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: CHILD DAY SCHOOL, LLC - ANTIOCH
FACILITY NUMBER: 073406638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2023
Section Cited

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement is not met as evidenced by:
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Facility has permanetly removed outlet. Deficiency has been cleared as of 01/25/2023.
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Per lead testing results, there was 1 drinking water outlets in room 1 with lead exceedance. Director states outlets have not been used since Nov 2022. Since they were in use before Nov 2022, this poses/posed potential risk to health/safety of children.
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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) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2