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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407412
Report Date: 03/16/2023
Date Signed: 03/16/2023 02:29:11 PM

Document Has Been Signed on 03/16/2023 02:29 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ST. AGNES PRESCHOOLFACILITY NUMBER:
073407412
ADMINISTRATOR:SCIACQUA, LORIFACILITY TYPE:
850
ADDRESS:3886 CHESTNUT AVETELEPHONE:
(925) 689-3990
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
03/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lori SciacquaTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection in regards to two faucets at the facility having lead exceedance.

Facility had the water tested 2/10/23. It was found that two faucets in the kitchen area, identified as faucets B and C, had lead that exceeded the acceptable amount of lead allowed in a child care center. The faucets identified have not been used for cooking or drinking water. Children bring their food from home and the faucet used for drinking water (faucet A) did not test with lead exceedance. The faucets that had lead exceedance have been replaced and the facility continues not to use these faucets. The facility will have the water retested. Director agrees to notify LPA of the retest date and send LPA the results of the testing.

Notice of Site Visit was provided and must be posted for 30 days.

Report was reviewed with Lori Sciacqua
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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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