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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408873
Report Date: 04/17/2024
Date Signed: 04/17/2024 10:42:26 AM

Document Has Been Signed on 04/17/2024 10:42 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:PASITOS SCHOOL, LLCFACILITY NUMBER:
434408873
ADMINISTRATOR/
DIRECTOR:		ANA GALVANFACILITY TYPE:
850
ADDRESS:801 HIBISCUS LANE ROOM ATELEPHONE:
(408) 244-3551
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 23DATE:
04/17/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:46 AM
MET WITH:Monica HernandezTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Andrea Cortez conducted an unannounced Case Management-Lead Testing/Exceedance inspection. LPA met with staff, Monica Hernandez, and explained the reason for the inspection. The purpose of this inspection is facility had two faucets, Faucet C and Faucet D that had a exceedance. Faucet C had a result of 12 ppb and Faucet D had a result of 6.5ppb.

During today's inspection, LPA observed the faucets. Faucet C is the drinking fountain inside and Faucet D is the left drinking fountain outside. LPAs observed that Faucet C was covered. Faucet D was not covered and is functioning. There was a cover, but was taken off due to water collecting in the drinking fountain. LPA explained that the faucets need to be inaccessible to children until the faucet is capped off. Facility cover Faucet D during today's inspection.

Licensee Tami Colon submitted plan to Licensing on 04/10/2024. Licensee stated that they are going cap off both faucets. Facility will use the Brita filer and cups for drinking water both inside and outside.

LPA also observed that there was water pooled in the drinking fountain outside. Facility removed water.

As a result of this inspection, Type B citations were issued. Exit interview conducted and report was reviewed with staff, Monica Hernandez. 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: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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 04/17/2024 10:42 AM - It Cannot Be Edited


Created By: Samantha Yip On 04/17/2024 at 10:11 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PASITOS SCHOOL, LLC
FACILITY NUMBER: 434408873

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
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 is not met as evident by:
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By POC 05/17/2024, facility will cap off both faucets and send proof to Licensing.
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Faucet C had a result of 12 ppb and Faucet D had a result of 6.5ppb. This poses a potential health and safety risk to 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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


LIC809 (FAS) - (06/04)
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