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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415311
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:28:08 AM


Document Has Been Signed on 03/30/2023 11:28 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOLFACILITY NUMBER:
274415311
ADMINISTRATOR:MICHELLE SKOGENFACILITY TYPE:
850
ADDRESS:345 EAST ALVIN DRIVETELEPHONE:
(831) 449-7536
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:100CENSUS: 54DATE:
03/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rosebelle Fairbanks TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA), Elizabeth Larios met with Site Director, Rosebelle Fairbanks, and explained purpose of visit, to follow-up on water lead testing conducted for the facility. Upon arrival, LPA toured the facility and located faucet "C" with reported Action Level Exceedance (value of 5.5 parts per billion or greater).

LPA Larios received the following lead testing documents via email from Site Director, Rosebelle Fairbanks: External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist Form (LIC9276), Facility Sketch (LIC999) labeled with locations of water outlets, and water lead test results.

Water sample conducted by McCampbell Analytical, Inc. on 11/19/2022 indicated faucet "C" had an Action Level Exceedance (ALE) value of 10. LPA observed that the faucet (sink/drinking fountain) is located in preschool classroom. LPA was informed by Rosebelle that "C" faucet (sink/drinking fountain) is being used for hand washing only & drinking fountain is not use due to children using there own water bottle or water container. Facility fully replaced faucet "C" (sink/drinking foundation) on 01/26/2023. LPA also received passing sample test result dated 02/18/2023 that is within reporting limits via email from Site Director, Rosebelle on 03/22/2023.

Exit interview conducted and report was reviewed with the Site Director, Rosebelle Fairbanks. Appeal Rights were also given.

As a result of todays inspection, a deficiency was cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2023
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 03/30/2023 11:28 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 274415311

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2023
Section Cited

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101700.3 Lead Testing Written Directives (b)(1) a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.This requirement was not met as evidenced by:
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Facility fully replaced faucet "C" (sink/drinking foundation) on 01/26/2023. Facility also provided passing sample test result that is within reporting limits
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After water lead testing was completed, the facility had one faucet (C) (sink/drinking fountain) located in preschool classroom with an Action Level Exceedance of 10, which poses a potential risk to the health, safety, and personal rights of children in care.
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CORRECTED DURING INSPECTION

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2023
LIC809 (FAS) - (06/04)
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