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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702027
Report Date: 12/08/2022
Date Signed: 12/08/2022 03:40:21 PM


Document Has Been Signed on 12/08/2022 03:40 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SUNNYVALE CHRISTIAN SCHOOLFACILITY NUMBER:
430702027
ADMINISTRATOR:DICKSON, MARGOFACILITY TYPE:
850
ADDRESS:445 SOUTH MARY AVENUETELEPHONE:
(408) 736-3286
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:98CENSUS: 55DATE:
12/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Margo DicksonTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Margo Dickson, Director, for an unannounced case management inspection. Purpose of today's inspection: discuss the lead testing requirement for child care centers that becomes effective January 1, 2023.

Margo states that the Facility does not use water outlets for drinking water or food preparation and wants to request to be "exempt" from the lead testing requirements. LPA advised Margo that the Facility will need to submit the following written attestation and document (Facility sketch) to the Department to be "exempt" from the lead testing requirement.

1) A written statement attesting to the CCC not using any water outlets used for food prep or drinking water

2) A marked-up Facility Map (LIC 999) to identify ALL outlets located at the CCC).

LPA reminded Margo that if the Facility decides to begin using an outlet(s) for food preparation or drinking water, after January 1, 2023, the Facility must first be tested following the most current written directives, prior to using the outlet(s).

Margo states that she understands LPA's explanation and will submit the items listed above to LPA Matos within 1-2 weeks.

Exit interview conducted and report was reviewed with Director, Margo Dickson. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022
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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