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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410602
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:22:32 PM

Document Has Been Signed on 07/20/2023 02:22 PM - 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:LIFE CONNECTIONS LEARNING CENTER - KINDERCAREFACILITY NUMBER:
434410602
ADMINISTRATOR:TIFFANY BRUNNINGSFACILITY TYPE:
840
ADDRESS:3571 NORTH FIRST STREETTELEPHONE:
(408) 424-3500
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 31DATE:
07/20/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tiffany BrunningsTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA), Mel Matos conducted an unannounced case management inspection to discuss the lead water testing and Action Level Exceedance (ALE) for one water fixture within the Facility. LPA met with Tiffany Brunnings, Executive Director, and explained purpose of today's inspection to her.

The initial lead testing was completed by Sol Environmental on October 23, 2022. An Action Exceedance Level (ALE) is a value of 5.5 parts per billion or greater. One water fixture, Fixture "E" reported an ALE of 14 parts per billion. Tiffany states that the water fixture was immediately removed from service and replaced after the initial lead testing report.

Tiffany states that Fixture "E" was retested on February 11, 2023 and the ALE for Fixture "E" was below 5.5 parts per billion. A copy of the lead testing report from Sol Environmental was provided to LPA via email prior to today's inspection.

The Self-Certification form (LIC 9275), Sampling Checklist form (LIC 9276) and updated Facility Sketch (LIC 999) was provided to LPA prior to today's inspection.

Exit interview conducted and report was reviewed with the Executive Director, Tiffany Brunnings. The following Type B deficiency is cited on the attached page (LIC 809-D). Copy of appeal rights was provided to Tiffany prior to the conclusion of today's inspection.

Notice of site visit was issued and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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 07/20/2023 02:22 PM - It Cannot Be Edited


Created By: Melvin S Matos On 07/20/2023 at 09:43 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: LIFE CONNECTIONS LEARNING CENTER - KINDERCARE
FACILITY NUMBER: 434410602

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives (b)(1) 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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Fixture "E" was immediately removed from service and replaced after the initial lead testing report. Fixture "E" was retested on February 11, 2023 and the ALE for Fixture "E" was below 5.5 parts per billion.
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Fixture "E" reported an ALE of 14 parts per billion. This poses a potential risk to the health, safety, and personal rights of children in care.
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Deficiency is thus cleared as of today's inspection.

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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:Diana Stephenson
LICENSING EVALUATOR NAME:Melvin S Matos
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


LIC809 (FAS) - (06/04)
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