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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280106152
Report Date: 03/27/2023
Date Signed: 03/27/2023 04:49:02 PM


Document Has Been Signed on 03/27/2023 04:49 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:YELLOW BRICK ROADFACILITY NUMBER:
280106152
ADMINISTRATOR:SLEVIN, KERRIFACILITY TYPE:
850
ADDRESS:222 SPRING STREETTELEPHONE:
(707) 255-9289
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:32CENSUS: 26DATE:
03/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Minda Kastan Robben, LicenseeTIME COMPLETED:
11:46 AM
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On 03/27/2023, Licensing Program Analyst (LPA), Y.Yang made a case management inspection visit and met with the facility's licensee Minda Kastan Robin. 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 faucet tested above the allowable level (5.5 ppb) of lead in the water: Sample Site, "B" (a drinking fountain located inside the children's bathroom), had a reading of 12ppb. All other sources of water that were tested had a reading below the allowable level of 5.5 ppb.

The facility removed the drinking fountain from service by turning off the water supply. The Licensee notified all staff members regarding the fountain and instructed staff to not use the fountain or turn on the water supply. Children in care are receiving drinking water from individual tumblers from home and from other drinking water sources located at the center. The Licensee stated that she plans to permanently remove the water fountain and cap the water supply.

The Licensee submitted the Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to LPA. The Licensee stated that she will submit the External Water Sampling Self-Certification Form (LIC 9275) to the LPA at a later date.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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 facility's Licensee, Minda Kastan Robben.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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 03/27/2023 04:49 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: YELLOW BRICK ROAD
FACILITY NUMBER: 280106152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2023
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.
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LPA observed that the facility has turned off the water supply to the drinking fountain located at “Site B” rendering it inoperable. The Licensee stated that the facility plans to permanently remove the water fountain and cap the water supply at the source. The Licensee stated that she will submit proof of removal to the LPA by 04/27/23.
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Based on a record review, the facility had one drinking fountain (Site “B”) that exceeded the allowable levels of lead in the water. Site B had a reading of 12ppb. This is a potential health and safety risk to 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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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