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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710595
Report Date: 10/26/2022
Date Signed: 10/26/2022 11:41:24 AM


Document Has Been Signed on 10/26/2022 11:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:GROWING FOOTPRINTS & GROWING FOOTSTEPS-LOS GATOSFACILITY NUMBER:
430710595
ADMINISTRATOR:MULLINS, CORYFACILITY TYPE:
850
ADDRESS:16575 SHANNON ROADTELEPHONE:
4083564442
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:84CENSUS: 18DATE:
10/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jamie NewtonTIME COMPLETED:
12:00 PM
NARRATIVE
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On October 26th, 2022 at 9:30 am, Licensing Program Analyst (LPA), Kassandra Medrano, conducted an unannounced case management inspection in response to a completed lead testing on 9/24/2022 which resulted in two action level exceedances within the facility of 8.1 ppb and 20 ppb. LPA met with the Director, Jamie Newton, and explained the nature of today's inspection.
Prior to today’s inspection, Community Care Licensing received notification of the lead exceedances by the water program. On 10/4/2022, LPA received documentation of completion of lead testing but there was no indication of exceedance within the facility. The director stated that Lead sampling was initiated by Jim Bracken, Facilities Manager. The facilities manager stated the water program did not notify facility of exceedance levels, and informed him that they would receive the results of the sampling within three weeks from date of testing, but facility has yet to receive those results. Preceding the arrival of LPA Medrano, both the fountains that have been found in exceedance have been taped off and are not being used. Facility is using kitchen for their only source of drinking water.
The water sample conducted by California Rural Water Association (CRWA) on 09/24/2022, indicated the following:
1) Water Fountain "B" outside of Preschool office has Lead Action Level Exceedance value of 8.1ppb.
2) Water Fountain "E" located within the Children's Ministry wing has Lead Action Level Exceedance of 20 ppb.
LPA has requested the following corrected documents during todays inspection:
1.Self-Certification LIC9275,
2.Sampling Checklist Form LIC9276
3.Facility Sketch LIC 999 (fully labeled with locations of all water outlets)
4. Full lead report from water program

Type B deficiency was cited, exit interview conducted, and a copy of this report was given and reviewed with the Director, Jamie Newton. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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Document Has Been Signed on 10/26/2022 11:41 AM - 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: GROWING FOOTPRINTS & GROWING FOOTSTEPS-LOS GATOS
FACILITY NUMBER: 430710595

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited

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Lead Testing Written Directives section 101700.3 (b)(1),
a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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This exceedance level found in “B” drinking fountain was 8.1 ppb and drinking fountain "E" was 20 ppb. This poses a potential risk to the Health, Safety, or Personal Rights of 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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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