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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413022
Report Date: 01/30/2023
Date Signed: 01/30/2023 03:21:15 PM


Document Has Been Signed on 01/30/2023 03:21 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:DAY STAR MONTESSORI SCHOOL, INC.FACILITY NUMBER:
434413022
ADMINISTRATOR:REGINE MONINA GANGOSOFACILITY TYPE:
850
ADDRESS:215 DEMPSEY ROADTELEPHONE:
(408) 263-1618
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:150CENSUS: 71DATE:
01/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Danah TopaciaTIME COMPLETED:
03:30 PM
NARRATIVE
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On Monday, January 30, 2023 at 2:30 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management - Lead Testing/Exceedance Visit. LPA met with the Director Danah Topacio and explained the nature of the visit. Present on this visit were staff 18 and 71 preschool children. The facility operates Monday to Friday from 7:30 am to 6 pm.

LPA discussed to the Director the PIN 21-21.1-CCP - WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS (CCC) PURSUANT TO AB 2370 CHAPTER 676, STATUTES OF 2018 https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21_1-CCP.pdf

Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer the health and safety requirements related to lead exposure and testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

The facility Sample ID 434413022 B – Location Luna Room Sink had a Lead Action Level of Exceedance Response. Sample date on 12/06/2022 and Analysis Date 12/08/2022. Plan of Correction on 12/16/2022 and Authorized Representative Notification via email on 12/19/2022. Luna Room Sink - faucet replaced on 12/19/2022. Re-test / sample date on 01/25/2023.

This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation. LPA generated a Proof of Correction Clearance Letter and provided a copy to the Director.

Exit interview was conducted with the Director Danah Topacio
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
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 01/30/2023 03:21 PM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: DAY STAR MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 434413022

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2023
Section Cited

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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.....
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LPA reviewed the Plan of Correction dated 12/16/2022 to the Director.
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The facility Sample ID 434413022 B – Location Luna Room Sink had a Lead Action Level of Exceedance Response of more than 5.5ppb. This poses a potential health, safety and personal rights risk to children in care.
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Luna Room Sink - faucet replaced on 12/19/2022. Re-test / sample date on 01/25/2023.


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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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
LIC809 (FAS) - (06/04)
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