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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408911
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:34:42 AM

Document Has Been Signed on 01/31/2024 11:34 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:GUIDING LIGHT MONTESSORI, LLCFACILITY NUMBER:
073408911
ADMINISTRATOR:STALEY, JUSINTAFACILITY TYPE:
850
ADDRESS:2041 OAK PARK BOULEVARDTELEPHONE:
(925) 954-1154
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 24DATE:
01/31/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Justina StaleyTIME COMPLETED:
10:00 AM
NARRATIVE
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On 1/31/24 Licensing Program Analyst (LPA) Monica Mathur met with Licensee, Justina Staley to conduct a Case Management inspection for the Lead Testing results at Center.

It was indicated that there was at least one (1) outlet that exceeded the Action Level established by the State for exposure. Faucet is located in the outdoor play ground, used for hosing down the play ground. Justina stated outlet was not used by children for drinking or food prep. LPA observed outlet has been decommissioned and covered with tape and plastic.

The lead exceedance posed a potential risk to health and safety, therefore deficiency is cited today on 809D page.

Exit interview conducted and report was reviewed with the Licensee, Justina Staley. A Notice of Site Visit was given and must remain posted for 30 days

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/31/2024 11:34 AM - It Cannot Be Edited


Created By: Monica Mathur On 01/31/2024 at 10:06 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: GUIDING LIGHT MONTESSORI, LLC
FACILITY NUMBER: 073408911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2024
Section Cited

101700.3(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care. This requirement is not met:
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LPA observed outlet has been decommissioned and covered with tape and plastic. Licensee will submit a plan of correction and either permanently remove or replace outlet no later than 2/29/24
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Per review,State Water Board report indicated there was at least one outlet that exceeded the Action Level established by the State for exposure. Faucet is located in the outdoor play ground, used for hosing down the play ground. This posed a potential risk.
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024


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