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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440700992
Report Date: 10/18/2022
Date Signed: 10/18/2022 04:38:27 PM


Document Has Been Signed on 10/18/2022 04:38 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:CHILDREN'S ENRICHMENT CENTERFACILITY NUMBER:
440700992
ADMINISTRATOR:SUZANNE BORRESONFACILITY TYPE:
850
ADDRESS:2701 CABRILLO COLLEGE DRIVETELEPHONE:
(831) 465-3302
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:120CENSUS: 80DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Marissa BorresonTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPA), Elizabeth Larios, conducted an unannounced Case Management inspection. LPA met with Assistant Director Laurita Reynolds and Facility Maintenance Director Nate Voeltz, and explained the purpose of the inspection. LPA reviewed water sample summary and requested Nate to identify faucets U, & V with reported Lead Action Level Exceedance of 5.5 parts per billion (ppb) or greater. LPA observed that sink faucet U and drinking fountain V are located in Room 4101. LPA observed that the faucet is being used for hand washing. Nate states that the U-sink faucet and V-drinking fountain were immediately stop in use when tested Lead Action Level Exceedance on 07/29/2022 until they passed on 08/29/2022 & 09/02/2022.

LPA obtained the following facility documents during today's inspection: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), and Facility Sketch (LIC999) labeled with locations of water outlets that were tested.

The water sample conducted by Source Flow Water Solutions on 07/29/2022, and 08/29/2022 indicated the following:

1) Faucet "U-Sink Faucet Room 4101 Preschool Bathroom" has Lead Action Level Exceedance value of 14.3 ppb.

2) Faucet "V-Drinking Fountain Room 4101 Preschool Bathroom" has Lead Action Level Exceedance of 5.6 ppb.

3) Faucet "U-Sink Faucet Room 4101 Preschool Bathroom" has Lead Action Level Exceedance value of 5.7 ppb.

As a result of this inspection, Type B deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Assistant Director, Laurita Reynolds.



A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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Document Has Been Signed on 10/18/2022 04:38 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CHILDREN'S ENRICHMENT CENTER
FACILITY NUMBER: 440700992

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
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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Based on record review, the Lead Sampling Report in two (2) identified faucets: U & V had elevated lead above 5.5 ppb. This poses a potential risk to the health, safety, or personal rights of children in care.
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Facility Maintance Director provided LPA with passing sample test results that are within reporting limits during 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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