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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710434
Report Date: 12/21/2022
Date Signed: 12/21/2022 11:01:16 AM

Document Has Been Signed on 12/21/2022 11:01 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:GEORGE MAYNE STATE PS/CHILDREN CTRFACILITY NUMBER:
430710434
ADMINISTRATOR:NANCY MORIN/M.DE LA TORREFACILITY TYPE:
850
ADDRESS:5030 N FIRST ST.TELEPHONE:
(408) 423-1717
CITY:ALVISOSTATE: CAZIP CODE:
95002
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 26DATE:
12/21/2022
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria De La TorreTIME COMPLETED:
11:15 AM
NARRATIVE
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On Wednesday, December 21, 2022 at 10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management - Lead Testing/Exceedance Visit. LPA met with the Director Maria De La Torre and explained the nature of the visit. Present on this visit were 8 staff and 26 preschool children. The facility operates Monday to Friday from 7:30 am to 5:30 pm.

LPA discussed to the Director 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 Director 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 430710434 F – Location Drinking Fountain Kitchen F2 R had a Lead Action Level of Exceedance Response. On 11/05/22 Sample Date, 11/30/2022 Analysis Date and 12/09/2022 Replaced. The Director stated that Re-testing will be ordered soon and LPA will be notified.

LPA confirmed the Plan of Correction (received via email on 12/08/2022) to the Director.

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 Director Maria De La Torre.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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 12/21/2022 11:01 AM - It Cannot Be Edited


Created By: Manel Estoesta On 12/21/2022 at 10:34 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: GEORGE MAYNE STATE PS/CHILDREN CTR
FACILITY NUMBER: 430710434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2022
Section Cited
CCR
101238(a)

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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.....


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LPA confirmed the Plan of Correction (received via email on 12/08/2022) to the Director. On 12/09/2022, the Drinking Fountain Kitchen F2 R was replaced.
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Sample ID 430710434 F – Location Drinking Fountain Kitchen F2 R had a Lead Action Level of Exceedance Response (Kitchen Faucset)of more than 5.5ppb. This poses a potential health, safety and personal rights risk to children in care.
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The Director stated that Re-testing will be ordered soon and LPA will be notified via email.

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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:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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