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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709449
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:59:48 PM


Document Has Been Signed on 03/21/2023 01:59 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:MORGAN HILL PARENT-CHILD NURSERY SCHOOLFACILITY NUMBER:
430709449
ADMINISTRATOR:STEFANIE ZOCCOLIFACILITY TYPE:
850
ADDRESS:16870 MURPHY AVENUETELEPHONE:
(408) 779-4515
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:24CENSUS: 9DATE:
03/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Elizabeth HuckabyTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Ashley Lopez conducted an unannounced Case Management- Lead Testing/Exceedance inspection. LPA met with staff, Elizabeth Huckaby, and explained the reason for the inspection. The purpose of this inspection is facility had three sinks with a lead exceedance of 5.5ppb.

During today's inspection, LPA inspected the sinks that had the exceedance, which were Sink A, Sink B, and Sink C. Sinks are located outside behind the shed located next to the chicken coop. Sink A had a result of 6.9ppb. Sink B had a results of 7.3 ppb and Sink C had a result of 19ppb. Sinks were covered with plastic. Facility will be using the sinks in the bathroom for hand-washing.
A copy of the LIC 999, LIC 9276, and LIC 9275 was emailed to Licensing on 11/28/2022. Facility will send a new water sample test result to Licensing by 04/21/2023.

As a results of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Elizabeth Huckaby. A notice of site visit was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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 04/18/2023 12:15 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/06/2023 05:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MORGAN HILL PARENT-CHILD NURSERY SCHOOL
FACILITY NUMBER: 430709449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited

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Lead Testing Written Directives. a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 
This requirement is not met as evident by:
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Facility only uses sinks for handwashing. A sign was posted that sinks are only used for handwashing. Facility only uses bottle water.
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Sink A had a result of 6.9ppb. Sink B had a result of 7.3ppb, and Sink C had a result of 19ppb. This poses 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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