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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274412008
Report Date: 05/23/2023
Date Signed: 05/23/2023 10:31:16 AM

Document Has Been Signed on 05/23/2023 10:31 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:CENTRAL BAY CHILDREN'S CENTERFACILITY NUMBER:
274412008
ADMINISTRATOR:PATRICIA LOPEZFACILITY TYPE:
830
ADDRESS:17500 PESANTE ROADTELEPHONE:
(831) 663-2997
CITY:SALINASSTATE: CAZIP CODE:
93907
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
05/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Olivia IbarraTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced case management inspection in response to a lead testing completed with an exceedance level. LPA met with Early Learning Supervisor Olivia Ibarra, and explained the nature of today's inspection to her.

During today's inspection LPA Macias requested and obtained the following documents; Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, fully labeled with locations of all water outlets, and full lead report. The lead exceedance reading was found in the laundry room. The laundry room is off limits to the children, and has never been used for drinking water. The center provides filtered drinking water for the children, as well as nutrition services.

During today's inspection LPA Macias observed the laundry off limits and securely gated. The sink/ faucet is exclusively used of laundry services.

Type B deficiency cited, exit interview conducted, and a copy of this report was reviewed with the Early Learning Supervisor Olivia Ibarra. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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 05/23/2023 10:31 AM - It Cannot Be Edited


Created By: Joseph Macias On 05/23/2023 at 09:37 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: CENTRAL BAY CHILDREN'S CENTER
FACILITY NUMBER: 274412008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives section 101700.3 (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 Macias requested and obtained the following documents; Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, fully labeled with locations of all water outlets, and full lead report.
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This exceedance level found in the
laundyr room was 7.6. This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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The sink/ faucet in the laundry is not used by the children and is in an off limits area.

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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:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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