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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703793
Report Date: 02/01/2023
Date Signed: 02/07/2023 10:59:15 AM

Document Has Been Signed on 02/07/2023 10:59 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:ROSE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430703793
ADMINISTRATOR:KATHLEEN LINCOLNFACILITY TYPE:
850
ADDRESS:250 A ROSWELL DRIVETELEPHONE:
(408) 635-2686
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: DATE:
02/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Juana CastilloTIME COMPLETED:
12:00 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
On Wednesday February 01, 2023 at 10:30 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management - Lead Testing/Exceedance Visit. LPA met with the Site Administrator on Duty Cheryl Rivera and Head Teacher Juana Castillo and explained the nature of the visit.

LPA discussed to the Site Administrator about the PIN 21-21.1-CCP - WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS (CCC) PURSUANT TO AB 2370 CHAPTER 676, STATUTES OF 2018 https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21_1-CCP.pdf
Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer the health and safety requirements related to lead exposure and testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

The facility Sample ID's 430703793 F & I had a Lead Action Level of Exceedance Response. The Sample taken on 12/08/2022 and Date of Analysis on 12/15/2022. Water Sample Results Reported on 12/19/2022. The facility developed a Plan of Correction via email on 12/21/2022.

This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation. LPA generated a Proof of Correction Clearance Letter and provided a copy to the Director.

Exit interview was conducted with the Site Administrator on Duty Cheryl Rivera.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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 2
Document Has Been Signed on 02/07/2023 10:59 AM - It Cannot Be Edited


Created By: Manel Estoesta On 02/01/2023 at 11:09 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: ROSE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430703793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited
CCR
101238(a)

1
2
3
4
5
6
7
101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.....
1
2
3
4
5
6
7
The facility developed a Plan of Correction via email on 12/21/2022. Part of he facility Remediation plan was by replacement of the water outlets that had a Lead Action Level of Exceedance Response.
8
9
10
11
12
13
14
The facility Sample ID's 430703793 F & I had a Lead Action Level of Exceedance Response which poses a potential health, safety and personal rights risk to children in care.
8
9
10
11
12
13
14
During the remediation plan, bottled water is being used in place of water outlets that are out of service. The facility is still working on water resampling.

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:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


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