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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404912
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:17:04 PM


Document Has Been Signed on 08/26/2022 04:17 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:ROSEMARY PRESCHOOLFACILITY NUMBER:
434404912
ADMINISTRATOR:HEATHER ELSTONFACILITY TYPE:
850
ADDRESS:401 WEST HAMILTON AVENUETELEPHONE:
(408) 341-7127
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:180CENSUS: 4DATE:
08/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Mylene IgnacioTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), James Santos arrived at the day care center today and met with Assistant Director, Mylene Ignacio.

The purpose of today's visit was to follow up on the plan of correction from the case management visit on 5/12/2022 which was for the Lead Sampling Testing conducted at the center on 4/16/2022 on which the testing of water supply on three (3) faucets located in the Rosemary Elementary kitchen and a faucet located in the Occupational Therapy (Rm H) indicated an Action Level Exceedance.

LPA received an email from Director, Heather Elston on 8/24/2022 with the new test results report water re-testing resulted in all fixtures below the 5ppb action level. Per report, the re-testing was conducted on 8/5/2022. The center received the test results on 8/19/2022.

Per review of documents, the daycare center has completed the plan of correction. Citation has been cleared.


No deficiency cited during today's visit. Exit interview conducted and a copy of this report was provided to the Assistant Director.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
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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