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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216516
Report Date: 10/10/2022
Date Signed: 10/10/2022 12:16:51 PM

Document Has Been Signed on 10/10/2022 12:16 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LA PETITE ACADEMY - PLEASANTONFACILITY NUMBER:
010216516
ADMINISTRATOR:THERESA GROSSFACILITY TYPE:
840
ADDRESS:5725 VALLEY AVENUETELEPHONE:
(925) 462-7844
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
10/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Theresa Gross TIME COMPLETED:
12:45 PM
NARRATIVE
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On October 10, 2022, License Program Analyst (LPA) Lorraine Dacanay Breaux met with Director Theresa Gross for an Unannounced Case Management Visit for Lead Testing Results at La Petite Academy- Pleasanton. Present for today's inspection was the Director and 10 additional Staff. During today's visit 0 children in care due to the facility being closed for holiday. The facility operates Monday - Friday from 7:00 AM - 5:30 PM.

LPA and Director toured the facility and LPA obtained photos of the faucets in the classrooms/Kitchen Area. It was indicated that an area exceeded the Action Level established by the stated for lead exposure. A Plan of correction was discussed with the Director. This facility is being given a TYPE B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number 1012238 (a) Buildings and Grounds. (See LIC 809-D) The facility is in the process of correcting.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Exit interview conducted and report was reviewed with the Director, Theresa Gross.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2022
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 10/10/2022 12:16 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 10/10/2022 at 11:21 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: LA PETITE ACADEMY - PLEASANTON
FACILITY NUMBER: 010216516

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited
CCR
101238(a)

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101238(a) Building and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to exsure the safety and well-being of children , employee and visitors. This requirement is not met as evidenced by:
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LPA has observed that the faucets have been replaced. Facility is scheduled to retest on 10/24 and 10/25/22 to make sure they are in compliance. The children are using personal water bottles that are refilled by filtered water purchased from the grocery store.
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Based on observation and documentaion of the Lead Testing Results, the facility has multiple water faucets for lead exposure that exceeds the 5PPB level. This is an potential risk to Health and Safety and/or personal rights risk to persons in care.
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Director must submit proof of correction to LPA via email, that the lead level is in compliance. The documentation must be submitted to LPA no later then 11/11/2022.
Email:
Lorraine.Dacanay-Breaux@dss.ca.gov

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


LIC809 (FAS) - (06/04)
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