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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280100646
Report Date: 09/09/2022
Date Signed: 09/09/2022 03:04:15 PM


Document Has Been Signed on 09/09/2022 03:04 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PRESBYTERIAN DAY SCHOOLFACILITY NUMBER:
280100646
ADMINISTRATOR:BATOR, JENNIFERFACILITY TYPE:
850
ADDRESS:1333 THIRD STREETTELEPHONE:
(707) 224-8941
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:44CENSUS: 26DATE:
09/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Jennifer Bator, DirectorTIME COMPLETED:
01:25 PM
NARRATIVE
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On 9/09/2022 at 11:55am, Licensing Program Analyst (LPA), Kevin O'Connell made a case management inspection and met with Facility Representative, Jennifer Bator.
The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following outlets/faucets tested above the allowable level (5.5 ppb) of lead in the water:
Faucet "F" - "kitchen sink faucet", 5.600 ppb
The staff have made the kitchen sink faucet inaccessible by:
Turning off the water to this faucet, placing a bag over the faucet and posting a sign stating " Do not use until removed by sampler- failure to comply will negatively impact ongoing lead sampling work required by California State Law".
The facility used this faucet very occasionally by the teachers to wash their hands and not any food preparation. The facility has used Alhambra bottled water since at least 2017 for drinking water.

The facility had a plumber make an inspection and recommended that the facility replace the copper pipe under the sink as well as the faucet.

The faucet will be replaced on 10/14/22 per the recommendations of the water test company as well as the copper pipe under the sink. A re sampling of the water will be made three weeks after the faucet is replaced. The facility will update CCL when they receive the results.

The following deficiency is being cited (see LIC 809D). 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. Exit interview conducted and report was reviewed with the Facilities Director, Jennifer Bator.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
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 09/09/2022 03:04 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: PRESBYTERIAN DAY SCHOOL
FACILITY NUMBER: 280100646

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2022
Section Cited

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101700.3(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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Based on record review, the facility had 1 faucet (faucet F) that exceeded that allowable levels of lead in the water (5.6 ppb). This is a potential health and safety risk to children in care.
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receive drinking water from bottled water and a water dispenser. The licensee will be replacing the faucet and additional pipe under the sink on 10/14/22, have retested three weeks later and send results to CCL by 11/15/22.
kevin.oconnell@dss.ca.gov

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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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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