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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407454
Report Date: 11/08/2022
Date Signed: 11/08/2022 12:21:14 PM


Document Has Been Signed on 11/08/2022 12:21 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:LITTLE FLOWERS MONTESSORI - MITCHELLFACILITY NUMBER:
073407454
ADMINISTRATOR:MELODY ANGLESFACILITY TYPE:
850
ADDRESS:2875 MITCHELL DRTELEPHONE:
(925) 322-0135
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:144CENSUS: 96DATE:
11/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melody AnglesTIME COMPLETED:
10:30 AM
NARRATIVE
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On Licensing Program Analyst (LPA) Monica Mathur met with Director, Melody Angles 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 that there was at least one outlet which exceeded the Action Level established by the State for exposure. This is a potential risk to health and safety of children in care. Director states the faucet is only used for hand washing, cleaning water bottles, and not used for drinking or food prep.

Deficiency is cited from the California Code of Regulations, Title 22 (see 809D). LPA discussed a Plan of Correction and facility will submit the documentation for the post-testing requirements.

Exit interview conducted and report was reviewed with Director, Melody Angles. 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: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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 11/08/2022 12:21 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: LITTLE FLOWERS MONTESSORI - MITCHELL
FACILITY NUMBER: 073407454

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2022
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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Based on Lead Testing Sample results the facility has one (1) water faucet with lead exposure. Director states children use this outlet to wash hands & water bottles but do not drink or food prep with it. This is a potential risk to Health and Safety or Personal Rights risk to 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: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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