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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009688
Report Date: 09/20/2023
Date Signed: 09/20/2023 01:46:43 PM

Document Has Been Signed on 09/20/2023 01:46 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MILA'S PRESCHOOL AND CHILDCARE CENTER-INFANTFACILITY NUMBER:
283009688
ADMINISTRATOR:CALLE, MILAGROSFACILITY TYPE:
830
ADDRESS:957 BROWN STREETTELEPHONE:
(707) 967-0774
CITY:ST. HELENASTATE: CAZIP CODE:
94574
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 9DATE:
09/20/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Milagros CalleTIME COMPLETED:
02:00 PM
NARRATIVE
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On 09/20/2023 at 12:30 PM, Licensing Program Analyst (LPA), Mindy Mohr made a case management inspection and met with Director, Milagros Calle. 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 of (5ppb) of lead in the water. Faucet "D" infant room staff hand washing sink, 6.900 ppb.

The staff have made the faucet inaccessible by shutting the water off to the faucet. Children in care are receiving drinking water from bottled water.

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 Director Milagros Calle.

Leslie Lepori
Melinda Mohr
DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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 09/20/2023 01:46 PM - It Cannot Be Edited


Created By: Melinda Mohr On 09/20/2023 at 12:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MILA'S PRESCHOOL AND CHILDCARE CENTER-INFANT
FACILITY NUMBER: 283009688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
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 the children in care.
This requirement was not met as evidenced by:
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On 09/07/23 licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for site "D". Water testing results indentified with Action Level Exceedence as defined in WD section 101700.3 are not deemed safe to drink. 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:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023


LIC809 (FAS) - (06/04)
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