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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408891
Report Date: 10/05/2022
Date Signed: 10/05/2022 12:39:56 PM

Document Has Been Signed on 10/05/2022 12:39 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:CLAYTON CHILDREN'S CENTERFACILITY NUMBER:
073408891
ADMINISTRATOR:MCCRACKEN, SANDYFACILITY TYPE:
850
ADDRESS:6760 MARSH CREEK ROADTELEPHONE:
(925) 672-4543
CITY:CLAYTONSTATE: CAZIP CODE:
94517
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 33DATE:
10/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sandy McCrackenTIME COMPLETED:
12:55 PM
NARRATIVE
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On 10/5/22, Licensing Program Analysts (LPAs), Melissa Guirit and Melissa Domantay met with Director Sandy McCracken for an unannounced case management inspection in regards to the lead testing of water in the child care center. Present for today's inspection were 33 children and 9 staff. A tour of the facility was conducted with Director and the faucet that read 5.5 ppb or greater was shown to LPAs. The faucet with the test results had a drinking fountain that was never used and is now removed. Per Director, it will no longer be in use anymore since the children already bring their own personal water bottles.

See 809-D for Type B deficiency.

Exit interview conducted with Director, Sandy. Appeal rights and notice of site visit provided. Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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 10/05/2022 12:39 PM - It Cannot Be Edited


Created By: Melissa Guirit On 10/05/2022 at 12:21 PM
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: CLAYTON CHILDREN'S CENTER
FACILITY NUMBER: 073408891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2022
Section Cited

101700.3(b)1)

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(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 Action Level Exceedance.

This is not evidenced by:
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Director agrees to remove the drinking fountain spout from the sink/faucet by POC due date.
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Based on sent test results to LPA of the Lead Testing inspection, the facility did not comply with the section cited above, which poses a potential risk to persons in care.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Melissa Guirit
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2022


LIC809 (FAS) - (06/04)
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