274410788-3-30-2023-07-CC-ELAS-CQF2SF-20230330173905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274410788
Report Date: 03/30/2023
Date Signed: 03/30/2023 05:39:15 PM

Document Has Been Signed on 03/30/2023 05:39 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	M.A.O.F. MOUNTAIN VALLEY EARLY LEARNING CENTER		FACILITY NUMBER:	274410788
ADMINISTRATOR:	VICKY SANTOS		FACILITY TYPE:	850
ADDRESS:	115 BARDIN ROAD		TELEPHONE:	(831) 771-9291
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 63	DATE:	03/30/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Lilia Suarez		TIME COMPLETED:	05:40 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA), Elizabeth Larios, met with Site Director, Lilia Suarez , and explained purpose of visit, to follow-up on water lead testing conducted for the facility. Upon arrival, LPA toured the facility and located drinking fountains & faucet "J, D, I H, F, and B" with reported Action Level Exceedance (value of 5.5 parts per billion or greater).

LPA Larios obtained the following lead testing document during inspection from Site Director, Lilia Suarez: External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist Form (LIC9276), Facility Sketch labeled with locations of water outlets, and water lead test results.

The facility has not submitted required documentation for water lead testing and LPA requested that the following document is submitted by 04/06/2023.

-Facility Sketch (LIC999) with drinking fountains & faucets clearly labeled with water lead testing letters.

LPA observed that drinking fountain J, is located in infant 2 classroom, drinking fountain B, is located in infant 1 classroom, drinking fountains D and F are located in infant 4 classroom, drinking fountain H is located in infant 3 classroom, and faucet I is located in kitchen. LPA observed and was informed by Site Director Lilia that drinking fountains "J, D, H, F, and B have been removed. Site Director Lilia states children are provided water via water dispenser and disposable cups.

Water sample conducted by Terra Environmental, Inc. on 11/05/2022 indicated the following:

1) J - drinking fountain classroom 2 has Lead Action Level Exceedance value of 33

ppb.

====CONTINUATION OF LIC 809 DATED 03/30/2023 PAGE 2====

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: M.A.O.F. MOUNTAIN VALLEY EARLY LEARNING CENTER	FACILITY NUMBER: 274410788
	VISIT DATE: 03/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

2) D - drinking fountain classroom 4 has Lead Action Level Exceedance value of 26.1 ppb.

3) I - kitchen-left cold water faucet classroom 2 has Lead Action Level Exceedance value of 21 ppb.

4) H - drinking fountain classroom 3 has Lead Action Level Exceedance value of 19.3 ppb.

5) F - drinking fountain classroom 4 has Lead Action Level Exceedance value of 16.2
ppb.

6) B - drinking fountain classroom 1 has Lead Action Level Exceedance value of 13
ppb.

LPA was informed and observed faucet "I" was fully replaced. Site Director Lilia provided LPA with passing samples test results that are within reporting limits during inspection.

Exit interview conducted and report was reviewed with the Site Director, Lilia Suarez. Appeal Rights were given.

As a result of todays inspection, a deficiency was cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 03/30/2023 05:39 PM - It Cannot Be Edited

Created By: Elizabeth Larios On 03/30/2023 at 02:37 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: M.A.O.F. MOUNTAIN VALLEY EARLY LEARNING CENTER	FACILITY NUMBER: 274410788
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/06/2023 Section Cited 101700.3(b)(1)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	LPA was informed and observed drinking fountains "J,D,H,F,B" have been removed and faucet "I" was fully replaced.
	8 9 10 11 12 13 14	After water lead testing was completed, the facility had six identified drinking fountains & faucet, "J,D,I, H, F, and B located in infant 1,2,3, and 4 classrooms & kicthen had elevated lead above 5.5 ppb. which poses a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14	Site Director Lilia provided LPA with passing samples test results that are within reporting limits during inspection. CORRECTED DURING INSPECTION.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Joel Segura

LICENSING EVALUATOR NAME:

Elizabeth Larios

LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3