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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703682
Report Date: 03/23/2023
Date Signed: 03/24/2023 08:56:00 AM

Document Has Been Signed on 03/24/2023 08:56 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:OCHOA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703682
ADMINISTRATOR:CHAVEZ, PERLINAFACILITY TYPE:
850
ADDRESS:902 ARIZONA CIRCLETELEPHONE:
(408) 842-2201
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 36TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
03/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Perlina ChavezTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Lead Testing/Exceedance inspection. LPA met with Site Director Perlina Chavez and explained the reason for the inspection. The purpose of this inspection is the facility had a fixture with a result of over 5.5ppb.
During today's inspection, LPA inspected the faucet with the action level exceedance. Fixture D is located in Room 5 and is a water fountain. It has a result of 7.5ppb. Director stated that they are currently not using the room and stopped using the room since 11/18/2023. LPA did not observe any children in the room during today's inspection. Water fountain was covered with plastic. The center has a water cooler for drinking water. The water spout has been replaced and they will be retesting the water. Site Director stated that a copy of the test results will be sent to Licensing upon receipt.

A copy of the LIC 9275, LIC 9276, LIC 999, test results, and work order was obtained during today's inspection.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Site Director Perlina Chavez. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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 03/24/2023 08:56 AM - It Cannot Be Edited


Created By: Samantha Yip On 03/23/2023 at 12:49 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: OCHOA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430703682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2023
Section Cited

101799.3(b)(1)

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Lead Testing Written Directives. a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 
This requirement is not met as evidence by:
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Faucet was covered with plastic.
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Fixture D, water fountain, in Room 5 had a result of 7.5ppb. This poses a potential risk to the health and safety to the children in care.
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The facility to submit a new water sample test result to Licensing by 05/03/2023.

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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023


LIC809 (FAS) - (06/04)
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