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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406724
Report Date: 04/13/2022
Date Signed: 04/13/2022 12:29:03 PM

Document Has Been Signed on 04/13/2022 12:29 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:CAPRI PRESCHOOLFACILITY NUMBER:
434406724
ADMINISTRATOR:HEATHER ELSTONFACILITY TYPE:
850
ADDRESS:850 CHAPMAN DRIVETELEPHONE:
(408) 341-7127
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 58TOTAL ENROLLED CHILDREN: 23CENSUS: 18DATE:
04/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Heather Elston, DirectorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced case management inspection visit today and met with Director. Heather Elston. LPA informed Director that purpose of visit which was to discuss the Lead Sampling Testing conducted at the center on 3/19/2022. The Lead Testing Analysis report was sent to CCL by the Director on 4/11/2022. Per the report, the testing of water on one of the faucets in the kitchen indicated an Action Level Exceedance, hence, water from this faucet is deemed not safe to drink or be used for food preparation due to elevated levels of lead. The sampling report dated 4/11/022 indicated result on the kitchen faucet of 9.9ppb which is above the reporting limit of 1.0ppb .

Per discussion with the Director, the identified faucet however, is not being used for any food preparation for the school nor for drinking. It is only being used by the kitchen staff only and for hand washing only. LPA inspected the faucet and a label for hand washing was observed to be posted by the sink.

Since the identified faucet is only being used for hand washing and by kitchen staff only and it is not accessible to children, there were no deficiencies cited.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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