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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408059
Report Date: 03/23/2023
Date Signed: 03/23/2023 11:14:40 AM


Document Has Been Signed on 03/23/2023 11:14 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-HARWOODFACILITY NUMBER:
434408059
ADMINISTRATOR:TRUMPP, KARIFACILITY TYPE:
850
ADDRESS:4949 HARWOOD ROADTELEPHONE:
(408) 723-0111
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:140CENSUS: 46DATE:
03/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kari TrumppTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Mel Matos and Ashley Lopez conducted an unannounced case management inspection to discuss the lead water testing and Action Level Exceedance (ALE) for three water outlets within the Facility. LPAs met with Kari Trumpp, director, and explained purpose of today's inspection to her.

The lead testing was completed by Healthy Building Science on December 17, 2022. An Action Exceedance Level is a value of 5.5 parts per billion or greater. Three water outlets (drinking fountains) - Fixture B (Room J1) reported an ALE of 13 parts per billion, Fixture C (Room J1) reported an ALE of 8.2 parts per billion, and Fixture K (staff computer room) reported an ALE of 10 parts per billion.

Kari states that the three drinking fountains were removed from service and drinking water was being provided only from drinking fountains that tested below the ALE value of 5.5 parts per billion. Kari states that the three drinking fountains were replaced on January 13, 2023 and were retested by Healthy Building Science on February 4, 2023. All three water outlets tested below 5.5 parts per billion. A copy of the testing results was provided to LPAs during today's inspection verifying the test results from February 4, 2023.

Kari agreed to submit the Self-Certification form (LIC 9275), Sampling Checklist form (LIC 9276) and updated Facility Sketch (LIC 999) to LPA Lopez by Friday March 31, 2023.

Exit interview conducted and report was reviewed with the Director, Kari Trumpp. The following Type B deficiency is cited on the attached page (LIC 809-D). Copy of appeal rights was provided to Kari prior to the conclusion of today's inspection.

Notice of site visit was issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/23/2023 11:14 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-HARWOOD
FACILITY NUMBER: 434408059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited

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Lead Testing Written Directives (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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Director states that the three water fountains were removed from service and drinking water was provided only from drinking fountains that have tested below the ALE value of 5.5 parts per billion.
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Fixture B (Drinking fountain - Room J1) reported an ALE of 13 parts per billion, Fixture C (Drinking fountain - Room J1) reported an ALE of 8.2 parts per billion, and Fixture K (Drinking fountain - staff computer room) reported an ALE of 10 parts per billion. This poses a potential risk to the health, safety, and personal rights of children in care.
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Director states that the three water fountains have been replaced and were retested on 02/04/23. Test results were below 5.5 ppb. Copy of test results was provided to LPAs.
Deficiency is thus cleared as of today's inspection.

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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) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
LIC809 (FAS) - (06/04)
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