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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480109880
Report Date: 06/24/2022
Date Signed: 06/24/2022 01:37:54 PM


Document Has Been Signed on 06/24/2022 01:37 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ST VINCENT FERRER PRESCHOOL AND DAY CAREFACILITY NUMBER:
480109880
ADMINISTRATOR:MUNSON, CANDIEFACILITY TYPE:
850
ADDRESS:400 FLORIDA STREETTELEPHONE:
(707) 552-6066
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:75CENSUS: 25DATE:
06/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Candie Munson - Center DirectorTIME COMPLETED:
01:50 PM
NARRATIVE
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On 06/24/2022 at 12:43pm, Licensing Program Analyst (LPA), Melchisedeck Augustin made a case management inspection and met with Director, Candie Munson. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5 ppb) of lead in the water: Sample Site, "B" - Hallway Drinking Fountain, 21.700ppb

The Center Director have made the faucet inaccessible by covering the fountain with a black plastic bag, posting an out of order and do not use signs on the fountain, and removing the fountain from service and children have no way of using it. The water to the drinking fountain has not been turned off as of yet, however; the Center Director stated she intended to shut the water off to prevent accidental use of the fountain. The facility filled a pitcher with water from the kitchen faucet which tested below the allowable level of (5ppb), and children in care are receiving drinking water by using cups to retrieve water from the pitcher. The Center Director submitted the External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to LPA.

The following deficiency is being cited (see LIC 809D). Appeal Rights was provided. 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.

Exit interview conducted and report was reviewed with the Director, Candie Munson.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
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 06/24/2022 01:37 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: ST VINCENT FERRER PRESCHOOL AND DAY CARE
FACILITY NUMBER: 480109880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2022
Section Cited

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Buildings and Grounds 101238(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. This requirement was not met as evidenced by:
Based on record review, the facility had 1 faucet that exceeded that allowable levels of
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lead in the water. This is a potential health and safety risk to children in care.
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from the kitchen faucet. Director stated the fountain would be replaced and retested by POC date and will submit plans regarding how that will be accomplished by 07/22/22.

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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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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