<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700603
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:30:40 AM

Document Has Been Signed on 08/07/2024 11:30 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:ST TIMOTHY'S PRESCHOOLFACILITY NUMBER:
430700603
ADMINISTRATOR/
DIRECTOR:		STACEY SULLIVANFACILITY TYPE:
850
ADDRESS:2094 GRANT ROADTELEPHONE:
(650) 967-4724
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
08/07/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Suzanne ScribnerTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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
On 8/7/2024 Licensing Program Analyst (LPA) Melanie Otsuji conducted a Case Management - Lead Testing/Exceedance Inspection. LPA met with the Facility Representative, Suzanne Scribner. LPA was provided a tour of the facility inside and out. Also present during today's visit was 1 additional staff member. Currently no children are present as facility is on summer break.

LPA discussed with the Facility Representative that Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer procedures for lead testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act. LPA discussed to the facility representative of the PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370 https://cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21-CCP.pdf
Sample ID D/D30 - Sink Faucet_Kitchen had a Lead Action Level of Exceedance Response of more than 5.5 ppb. The facility representative stated they have not utilized the sink since COVID started in 2020. It was previously utilized for food preparation. LPA observed the faucet to be off limits to children in care. Facility has a water delivery service that they utilize to provide drinking water to children. Facility does not do any food preparation on site any longer. Facility maintenance staff stated that valves will be replaced with a lead free fixture and spout will be retested. LPA confirmed the Plan of Correction with the facility representative.
Please see LIC 809D page for the citation.
Appeal rights provided. Exit interview was conducted with Facility Representative, Suzanne Scribner.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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 2
Document Has Been Signed on 08/07/2024 11:30 AM - It Cannot Be Edited


Created By: Melanie Otsuji On 08/07/2024 at 10:58 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST TIMOTHY'S PRESCHOOL
FACILITY NUMBER: 430700603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2024
Section Cited

101700.3(b)(2)

1
2
3
4
5
6
7
 Lead Testing Written Directive- 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.
1
2
3
4
5
6
7
Facility maintenance staff stated they will install a new lead-free fixture to replace the existing fixture. Spout will be retested. Facility is to inform LPA when outlet is retested and when results are received.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on record review, facility had outlet D water test 5.5 ppb or greater, which is a potential health and safety risk to persons in care.
8
9
10
11
12
13
14

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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2