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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410738
Report Date: 03/23/2023
Date Signed: 03/23/2023 02:57:49 PM


Document Has Been Signed on 03/23/2023 02:57 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:BRADLEY STATE PRESCHOOLFACILITY NUMBER:
444410738
ADMINISTRATOR:MARIA ROSA HERNANDEZFACILITY TYPE:
850
ADDRESS:321 CORRALITOS ROADTELEPHONE:
(831) 786-1872
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:22CENSUS: 13DATE:
03/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria Rosa HernandezTIME COMPLETED:
03:11 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Supervisor, Maria Rosa Hernandez, and explained purpose of today's visit- to follow-up on water lead testing conducted for the facility. Upon arrival, LPA toured the facility and requested Maria identify the faucet with Action Level Exceedance (ALE)- a value of 5.5 parts per billion or greater.

Water lead testing was conducted on 12/14/2022 and indicated that faucet "A" (a drinking fountain located in the preschool classroom) had an ALE of 6.0. The faucet has been fully replaced and is currently being flushed until it can be retested for lead. Additionally, the faucet is covered with a bag and has been made inaccessible to children. Drinking water is being provided by a separate drinking fountain located in the classroom. LPA requested that the facility update Licensing when a retest date has been confirmed for faucet "A" and advised that the results be submitted once retesting is completed.

The facility has not submitted required documentation for water lead testing and LPA requested that the following documents are submitted by 3/31/2023:

-Self-Certification completed by Certified External Water Sampler (LIC9275)


-Sampling Checklist Form (LIC9276)
-Facility Sketch (LIC999) with faucets clearly labeled with water lead testing letters
-Water lead test results

Exit interview conducted and report was reviewed with the Site Supervisor, Maria Rosa Hernandez.

As a result of todays inspection, a deficiency was cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
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 02:57 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: BRADLEY STATE PRESCHOOL
FACILITY NUMBER: 444410738

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/31/2023
Section Cited

101700.3(b)(1)

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101700.3 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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The facility fully replaced faucet A and has made it inaccessible until retesting can be completed. Results for lead retesting should be submitted upon completion.

LPA requested the facility update Licensing on the date water lead retesting is scheduled.
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After water lead testing was completed, the facility had one faucet (A) located in the preschool classroom with an Action Level Exceedance of 6.0, which poses a potential risk to the health, safety, and personal rights of children in care.
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Additionally, all required documentation (LIC9275, LIC9276, LIC999, water lead test results) should be submitted to the Department by 3/31/2023.

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
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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