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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414450
Report Date: 10/12/2022
Date Signed: 10/12/2022 11:15:48 AM

Document Has Been Signed on 10/12/2022 11:15 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:MOUNTAIN VIEW PARENT NURSERY SCHOOLFACILITY NUMBER:
434414450
ADMINISTRATOR:KOUKOUTSAKIS, CLAIREFACILITY TYPE:
850
ADDRESS:1535 OAK AVENUETELEPHONE:
(650) 969-9506
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 48TOTAL ENROLLED CHILDREN: 107CENSUS: 32DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Carrie KoukoutsakisTIME COMPLETED:
11:45 AM
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 10/12/2022 at 9:45am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced visit to the facility for the purpose of a Case Management visit to discuss the results of recent lead testing performed. LPA met with Director, Claire Koukoutsakis. Also present during today's inspection was 32 children and 5 staff. This facility is a parent co-op and present today were 13 parents.

A lead test completed for water locations intended for human consumption for faucets within the facility. On 08/30/2022, samples were collected from 6 faucets within the facility. 1 faucet, labeled "B-Drinking Fountain_Grass Area" is an outdoor drinking fountain which test results showed a level of 16 ppb level of lead. A result of 5.5 ppb or greater is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction. The remaining 5 faucets that were tested had results either below 5.5 ppb or had no measurable level of lead detected, "Analyte Not Detected - ND".

The fountain was taken out of use since March 2020 due to COVID and has not been in use since. During an annual inspection which LPA Uribe performed on 10/06/22, it was observed that this outdoor drinking fountain was closed and covered to prevent being used.

The center director believes the water fountain may not have been properly flushed prior to the sampling and therefore caused a false reading. A Plan of Correction has been discussed with the director and one of the following actions will be taken to remedy the issue:
1. The faucet on the fountain to be replaced and a new sample will be conducted; or
2. The fountain will be permanently closed and removed

A Type B Deficiency was issued today, see LIC 809D. A Notice of Site Visit was given and must be posted for 30 days. Appeal rights were given and reviewed. Exit interview conducted and report was reviewed with the director, Claire Koukoutsakis.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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 10/12/2022 11:15 AM - It Cannot Be Edited


Created By: Christina Uribe On 10/12/2022 at 10:55 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: MOUNTAIN VIEW PARENT NURSERY SCHOOL
FACILITY NUMBER: 434414450

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2022
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.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
A Plan of Correction has been discussed with the director and one of the following actions will be taken to remedy the issue:
1. The faucet on the fountain to be replaced and a new sample will be conducted; or
2. The fountain will be permanently closed and removed
8
9
10
11
12
13
14
One outdoor drinking fountain, which has not been in use since 03/2020, was tested for lead and the results showed a level of 16 ppb, which poses a potential health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
The director will complete the plan of correction to clear the deficiency and will notify LPA Uribe when the correction has been made. If a new test is performed or the foutain is removed, director will email the sampling results or a photo of the removed fountain no later than the due date of 11/14/22.
christina.uribe@dss.ca.gov

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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022


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