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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216686
Report Date: 12/07/2023
Date Signed: 12/07/2023 11:51:51 AM

Document Has Been Signed on 12/07/2023 11:51 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTEVERDE SCHOOL, THEFACILITY NUMBER:
010216686
ADMINISTRATOR:TAYLOR, T. & BROWN, E.FACILITY TYPE:
850
ADDRESS:2727 COLLEGETELEPHONE:
(510) 848-3313
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 27DATE:
12/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Tristen TaylorTIME COMPLETED:
12:00 PM
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
Licensing Program Analyst (LPA) Diana Campos met with Center Director Tristen Taylor to conduct an unannounced case management inspection regarding a lead exceedance from one faucet at the preschool center. The children's bathroom sink identified as faucet C exceeded the acceptable amount of lead allowed in a child care center. During the unannounced inspection LPA toured the facility for a health and safety check. Present during the inspection were 7 staff and 27 children in care.

LPA observed the faucet identified as faucet C. Director stated that faucet has been replaced and sink was retested on 11/14/23. The facility received the results of the post remediation testing on 11/28/23 and no exceedances were found. The lead deficiency is being cited and corrected today as a result of this visit.

See 809-D for deficiency.

Exit interview conducted and report reviewed with Center Director Tristen Taylor.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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 12/07/2023 11:51 AM - It Cannot Be Edited


Created By: Diana Campos On 12/07/2023 at 11:27 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTEVERDE SCHOOL, THE
FACILITY NUMBER: 010216686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
Lead Testing Written Directive
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Facility has replaced the faucet identified as faucet C and retested it on 11/14/23 and the results report no exceedance. This deficiency is being corrected during today's visit.
8
9
10
11
12
13
14
Based on record review a faucet at the facility (identified as faucet C) used by children had a lead exceedance, which poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

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:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


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