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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415093
Report Date: 05/12/2022
Date Signed: 05/12/2022 12:35:34 PM


Document Has Been Signed on 05/12/2022 12:35 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 INFANT CENTERFACILITY NUMBER:
434415093
ADMINISTRATOR:HEATHER ELSTONFACILITY TYPE:
830
ADDRESS:401 WEST HAMILTON AVENUETELEPHONE:
(408) 341-7127
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:16CENSUS: 5DATE:
05/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Heather ElstonTIME COMPLETED:
12:40 PM
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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 4/16/2022. The Lead Testing Analysis report was sent to CCL by the Director on 5/5/2022. Per report, 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, hence, water from this faucet is deemed not safe to drink or be used for food preparation due to elevated levels of lead. The water sampling report dated 4/16/2022 from Moore Twining Associates, Inc. indicated results on the identified Sites are above the reporting limit of 5ppb.

LPA inspected the identified faucets. Per discussion the Director, the identified faucets however, are not being used nor accessible to their infant program. The identified faucets are not being used to prepare meals for the infants. All infants' meals, food and water are provided by the parents.

Since the identified faucets are not accessible to their infant program, there are no deficiencies cited.


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: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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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