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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270702033
Report Date: 11/01/2023
Date Signed: 11/02/2023 10:40:06 AM

Document Has Been Signed on 11/02/2023 10:40 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MELODYPARK CHRISTIAN DAYCARE SCHOOLFACILITY NUMBER:
270702033
ADMINISTRATOR:ANGIE CASTROFACILITY TYPE:
850
ADDRESS:1130 SAN VINCENTE AVENUETELEPHONE:
(831) 422-5311
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 111TOTAL ENROLLED CHILDREN: 50CENSUS: 43DATE:
11/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Angie CastroTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Farida Raja, conducted an unannounced case management inspection to discuss the water lead testing which resulted in one action level exceedance at the facility. LPA met with Director, Angie Castro, and Business Manager, Johnna Meister and explained the purpose for the inspection. At 9:55am, LPA and Director conducted a facility walk through. LPA observed 43 children and 6 teachers within the indoor and outdoor areas toured. LPA requested to identify Sample Site ‘N’ with reported Action Level Exceedance (value of 5.5 parts per billion or greater value). The lead testing completed on August 12, 2023 by Enthalpy Analytical indicated site "N" had an Action Level Exceedance (ALE) value of 6.9 ppb.

LPA observed the drinking water fountain with the ALE is located in the gymnasium. Director and Business Manager stated that after obtaining results of the water lead test report they covered the drinking fountain and made it inaccessible to children in care. They plan to replace the faucet and get it re-tested. LPA observed the covered drinking water fountain in the gymnasium area. Director stated that children only use this area if it is raining and they are unable to go outdoors. Drinking water is provided through individual water bottles that children bring with them.

The following documents were submitted to analyst during today's inspection:
1) External Water Sampler Self-Certification Form (LIC9275).
2) Childcare Center Sampling Checklist Form (LIC9276).
3) Facility Sketch (LIC999) labeled with locations of water outlets that were tested, and
4) Water Lead Test Report by Enthalpy Analytical.

Type B deficiency was cited, exit interview conducted, and a copy of this report was given and reviewed with the Director, Angie Castro. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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 11/02/2023 10:40 AM - It Cannot Be Edited


Created By: Farida Raja On 11/01/2023 at 10:23 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MELODYPARK CHRISTIAN DAYCARE SCHOOL
FACILITY NUMBER: 270702033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2023
Section Cited

101700.3(b)(1)

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101700.3 Lead Testing Written Directives (b)(1) a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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During today's inspection, LPA observed that the drinking fountain with the ALE has been made inoperable and inaccessible to children in care. Children use individual water bottles which are refilled with water from the kitchen or classrooms for drinking purposes.
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After water lead testing was completed, the facility had one water fountain (N) located in the gymnasium with an Action Level Exceedance of 6.9 ppb, which poses a potential risk to the health, safety, and personal rights of children in care.
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Director and Business Manager stated that they are working to replace and retest the water fountain. Results for lead retesting should be submitted upon completion.

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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


LIC809 (FAS) - (06/04)
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