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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416983
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:43:39 PM

Document Has Been Signed on 11/17/2022 02:43 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:GILROY HEAD STARTFACILITY NUMBER:
434416983
ADMINISTRATOR:EVA SUAREZFACILITY TYPE:
850
ADDRESS:9300 WREN AVENUETELEPHONE:
(669) 212-8692
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 21DATE:
11/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Martha MoralesTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Elana Soto, teacher, and explained the reason for the inspection. The purpose of this inspection is lead testing completed with an exceedance. The facility had a result of 5.4 ppb. Site Director Martha Morales arrived shortly after.

During today's inspection, LPA inspected the kitchen sink, which had an exceedance. There was a plastic covering the sink faucet and four 2.5 gallon water jugs by the sink. Facility is using the water jugs to prepare food. LPA observed that maintenance was working on the sink during today's inspection, who replaced the faucet. Site Director stated that they will be doing another test. Facility will send test results once received.

As a result of this inspection, no deficiencies were issued. Exit interview was conducted and report was reviewed with Director Martha Morales. A notice of site visit has been issued and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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