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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408058
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:41:00 AM


Document Has Been Signed on 03/15/2023 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CHALLENGER SCHOOL-SHAWNEEFACILITY NUMBER:
434408058
ADMINISTRATOR:CHRISTEL SORIANOFACILITY TYPE:
850
ADDRESS:500 SHAWNEE AVENUETELEPHONE:
(408) 365-9298
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:154CENSUS: 65DATE:
03/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Christel SorianoTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Janette Cruz, and Cynthia Tamayo conducted an unannounced case management inspection and met with Christel Soriano, Director. LPAs explained the purpose of today’s inspection is to follow-up lead testing completed on 12/17/22 that indicated a water outlet found to have Action Level Exceedance (ALE) of 6.1 ppb. Census was taken, LPAs observed 65 children with total of seven staff supervising. LPAs reviewed the water sample summary and requested Director to identify water faucet “I” located in Room B3 with reported ALE of 6.1 ppb. LPAs noted that on 02/04/23 water retesting was completed for water faucet “I” by water sampler vendor, Healthy Building Science. Retesting results indicated that water faucet "I" in Room B3 passed within required levels of 5ppb meeting California requirements. LPAs observed that water outlet "I" is now being used by children and staff assigned in Room B3.

The following required documents have been received: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), Facility Sketch (LIC999) labeled with locations of water outlets that were tested and water retesting summary conducted by Healthy Building Science on 2/4/23..

As a result of this inspection, Type B deficiency was cited on the following page.
Exit interview conducted and report was reviewed with Director, Christel Soriano.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
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 03/15/2023 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CHALLENGER SCHOOL-SHAWNEE
FACILITY NUMBER: 434408058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
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 was not met as evidenced by:
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On today's inspection, Director provided LPAs with new water sample retest results that passed within required levels of 5ppb meeting California requirements. Deficiency cleared.
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Based on observation and record review, the Lead Sampling Report on 12/17/22 indicated that water outlet "I" in Room B3 had elevated lead of 6.1 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: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
LIC809 (FAS) - (06/04)
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