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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430704133
Report Date: 12/14/2022
Date Signed: 12/15/2022 09:12:05 AM

Document Has Been Signed on 12/15/2022 09:12 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:BRACHER CHILDREN'S CENTERFACILITY NUMBER:
430704133
ADMINISTRATOR:SILVIA BEJARANOFACILITY TYPE:
850
ADDRESS:2401 BOWERS AVENUETELEPHONE:
(408) 423-1228
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 18DATE:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Silvia BejaranoTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Anna Morales conducted an unannounced Case Management inspection. LPA met with Site Supervisor Silvia Bejarano in Classroom B, and explained the purpose of the inspection. LPA reviewed water sample summary and requested staff to identify Drinking Fountain In Room A Kitchen Bubbler. with reported Lead Action Level Exceedance of 5.5 parts per billion (ppb) or greater.

LPA observed that the Drinking Fountain KITCHEN BUBBLER is located in Room A. LPA observed that the Drinking Fountain KITCHEN BUBBLER is covered with plastic. Teacher Jennifer Guabatan states that the facility has not used CLASSROOM A and the drinking fountain KITCHEN BUBBLER since the end of May 2022.

On November 21,2022, LPA obtained the following facility documents: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), and Facility Sketch (LIC999) labeled with locations of water outlets that were tested.

The water sample conducted by California Rural Water Association (CRWA) on 11/23/2022 indicated the following:
1) Faucet- -Drinking Fountain Room- ROOM A KITCHEN BUBBLER has Lead Action Level Exceedance value of 18 ppb.
As a result of this inspection, Type B deficiency was cited on the following page. Exit interview conducted and report was reviewed with Director Silvia Bejarano.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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 12/15/2022 09:12 AM - It Cannot Be Edited


Created By: Anna Morales On 12/14/2022 at 12:52 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: BRACHER CHILDREN'S CENTER
FACILITY NUMBER: 430704133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
101700.3(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 was not met as evidenced by:
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The fountain is covered with plastic and currently not being used. The children are using water from other water fountains to refill their individual water container if needed..
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Based on record review, the Lead Sampling Report in one (1) identified Kitchen Bubbler/ Drinking Fountain in Room A had elevated lead above 5.5 ppb. This poses a potential risk to the health, safety, or personal rights of children in care.
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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:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022


LIC809 (FAS) - (06/04)
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