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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709420
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:47:35 PM

Document Has Been Signed on 01/31/2023 01:47 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MILPITAS CHRISTIAN PRESCHOOLFACILITY NUMBER:
430709420
ADMINISTRATOR:SHEILA TANIMURAFACILITY TYPE:
850
ADDRESS:1000 S. PARK VICTORIA DRIVETELEPHONE:
(408) 945-6530
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 180TOTAL ENROLLED CHILDREN: 180CENSUS: DATE:
01/31/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Sheila TanimuraTIME COMPLETED:
02:00 PM
NARRATIVE
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On Tuesday, January 31, 2023 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management - Lead Testing/Exceedance Visit. LPA met with the Director Sheila Tanimura and explained the nature of the visit.

LPA discussed to the Director the PIN 21-21.1-CCP - WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS (CCC) PURSUANT TO AB 2370 CHAPTER 676, STATUTES OF 2018 https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21_1-CCP.pdf
Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer the health and safety requirements related to lead exposure and testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

The facility Sample ID's 430709420 C, D, I & S had a Lead Action Level of Exceedance Response. Sample taken on 12/17/2022 and Date of Analysis on 01/06/2023. Water Sample Results Reported on 01/09/2023. The facility developed a Plan of Correction (POC) via email on 01/26/2023. The facility's POC are to immediately stopped using the water outlets and have directed children to use alternate outlets. Also, the facility is working on water outlet replacement and retesting.

This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation.

Exit interview was conducted with the Director, Sheila Tanimura.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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 01/31/2023 01:47 PM - It Cannot Be Edited


Created By: Manel Estoesta On 01/31/2023 at 01:04 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MILPITAS CHRISTIAN PRESCHOOL
FACILITY NUMBER: 430709420

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/01/2023
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.....
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The facility developed a Plan of Correction (POC) via email on 01/26/2023. The facility's POC are to immediately stopped using the water outlets and have directed children to use alternate outlets.
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The facility Sample ID's 430709420 C, D, I & S had Lead Action Level of Exceedance Response which poses a potential health, safety and personal rights risk to children in care.
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The facility is working on water outlet replacement and retesting, and will send an email to LPA.

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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:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023


LIC809 (FAS) - (06/04)
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