444413303-6-21-2023-07-CC-CNEN-CSZU2Y-20230621151244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444413303
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:12:49 PM

Document Has Been Signed on 06/21/2023 03:12 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:	COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER		FACILITY NUMBER:	444413303
ADMINISTRATOR:	ISIS GREENSPAN		FACILITY TYPE:	830
ADDRESS:	8500 HIGHWAY 9		TELEPHONE:	(831) 336-2857
CITY:	BEN LOMOND	STATE: CA	ZIP CODE:	95005
CAPACITY:	16	CENSUS: 0	DATE:	06/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Jamie Delaney & Lisa Hindman Holbert		TIME COMPLETED:	03:22 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Site Supervisor, Jamie Delaney, to conduct unannounced Required- 1 Year Inspection. LPA was granted access to the facility by Jamie and toured both indoors and outdoors during the inspection. Upon arrival, LPA was notified by Jamie that there are currently no infants or toddlers enrolled at the facility. Jamie states that there is advertising for the program, however due to challenges with staffing and enrollment, the infant/toddler areas have not been used for quite some time. LPA observed that the infant room is not set-up for the care of children and the outside play yard is unkempt and should not be used for children. LPA observed that the toddler room is appropriately set-up for children. LPA called Administrator, Lisa Hindman Holbert, to discuss inactive status for the infant/toddler license as the rooms and outdoor space are not properly set-up for children. Lisa agreed to place the license on inactive status until the rooms/outside space are set-up properly for the safe care of children and there is sufficient staffing for enrollment. LPA received completed Request for Inactive Status from Lisa and observed the facility will be inactive until 8/4/2023. A follow-up inspection will be conducted once the inactive status has ended to ensure the facility is ready to resume care of children.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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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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: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER	FACILITY NUMBER: 444413303
	VISIT DATE: 06/21/2023

NARRATIVE

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LPA additionally reviewed water lead testing completed for the facility on 12/15/2022 and again on 12/29/2022 and observed that an Action Level Exceedance (ALE) of 8.0ppb was found for Faucet "C" in the toddler room. Another ALE was observed upon retesting on 12/29/2022 for Faucet "I" in the infant room. (ALEs are any results with a value of 5.5ppb or greater.)

Per the Written Directives for child care centers, water sampling appointments cannot occur during extended breaks, vacations, holidays, or other shut downs. Because the test was conducted while the infant and toddler rooms were not in use, the water lead results did not meet the requirements of the Written Directives. Water lead testing should be completed while children are in care to ensure build up of lead is not present in faucets that are not used frequently. LPA requested that any retesting results are submitted to the Department.

Exit interview conducted and report was reviewed with the Site Supervisor, Jamie Delaney and Administrator, Lisa Hindman Holbert.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/21/2023 03:12 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: COMMUNITY BRIDGES EED HIGHLANDS PARK CENTER	FACILITY NUMBER: 444413303
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101701(a)

101701 Preparation Prior to Water Sampling Appointment (a) Water sampling appointments cannot occur during extended breaks, vacations, holidays, or other shutdowns. Prior to sampling, all water outlets shall be evaluated to determine if testing is required pursuant to subsection (b). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above as water faucets were tested while children were not present, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/22/2023
	Plan of Correction
1 2 3 4	POC has been cleared. Faucet "A" has been retested and no longer has ALE. Faucet "I" is not used for drinking water and did not need testing. LPA advised upon end of inactive status to confirm all faucets used for drinking water are appropriately tested for lead following the Written Directives.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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