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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211160
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:46:02 AM

Document Has Been Signed on 12/19/2023 11:46 AM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FIRST LUTHERAN CHRISTIAN PRESCHOOLFACILITY NUMBER:
070211160
ADMINISTRATOR:SMITH, JENIFACILITY TYPE:
850
ADDRESS:4006 CONCORD BOULEVARDTELEPHONE:
(925) 798-5330
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 35DATE:
12/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tammy DubeTIME COMPLETED:
12:00 PM
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On 12/19/23 at 10:30am, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Sikia Blue arrived at the center for an unannounced case management inspection. LPM and LPA met with Tammy Dube, the assistant director, and then with the director Jeni Smith who arrived shortly after LPM and LPA arrived. There were 35 children and 5 additional staff also present.

The facility completed the required lead testing of water outlets, and outlets C, D and I were found to be in exceedance of the Action Level of 5 ppb. The outlets are located in the building that houses the gym and another kitchen. The director stated that they do not use the outlets that were in exceedance, but they were tested as they were clear on what to test. LPM observed that outlet I is a water fountain in the hallway, is covered and has an out of order sign attached to it. LPM observed that outlets C and D are in the kitchen and the water has been turned off, so no water is coming out of the fixture. All outlets are not accessible to children at this time. The facility was provided a copy of the test results and it will be posted on the parent board. The facility plans to have the outlets repaired and retested, or replaced. The facility understands that they are unable to use the outlets until they receive the test results, and the Action Level is 5 ppb or below.

See LIC 809D for a deficiency being cited today. An exit interview was conducted with Jeni Smith, and a copy of this report, a Notice of Site Visit, and appeal rights were provided. The facility was reminded to have the Notice of Site Visit posted for 30 days.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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Document Has Been Signed on 12/19/2023 11:46 AM - It Cannot Be Edited


Created By: Loretta Dyson On 12/19/2023 at 11:06 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FIRST LUTHERAN CHRISTIAN PRESCHOOL
FACILITY NUMBER: 070211160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/19/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an
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The facility is working on replacing the drinking fountain outlet, and will be replacing the fixtures in the kitchen. The facility will submit proof of new test results, with Action Level at 5ppb or below, by 1/19/24.
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Action Level Exceedance.
This requirement has not been met as evidenced by the lead testing results received, indicating that three outlets on the grounds of the facility had results in exceedance of the 5 ppb Action Level. This poses a potential risk to the children in care.
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The facility understands that they cannot use the outlet until the Action Level is determined to be 5 ppb or below.

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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:Diane Perez
LICENSING EVALUATOR NAME:Loretta Dyson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023


LIC809 (FAS) - (06/04)
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