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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411305
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:26:20 PM

Document Has Been Signed on 04/26/2023 03:26 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:QUARRY LANE SCHOOL, THEFACILITY NUMBER:
013411305
ADMINISTRATOR:ELIZABETH VILLARREALFACILITY TYPE:
830
ADDRESS:3750 BOULDER STREETTELEPHONE:
(925) 846-9400
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 33TOTAL ENROLLED CHILDREN: 33CENSUS: 7DATE:
04/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Elizabeth Villarreal TIME COMPLETED:
04:00 PM
NARRATIVE
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On April 26, 2023, License program Analyst (LPA) Lorraine Dacanay Breaux conducted a unannounced Case Management - Lead Testing/Exceedance Visit. LPA met with the Director Elizabeth Villarreal and explained the nature of the visit. LPA Toured the facility for Health and Safety. There were 7 children in care with 2 fingerprint cleared staff.

On March 24, 2023, the sampling vendor pulled the water samples. Lab results analyzed found that location in the water fountain is in the toddler yard. This water fountain lead levels values greater than 5.5 ppb is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction. Currently, children bring their own bottled water from home and if when needed, the water bottles are refilled from the kitchen faucet and/or staff kitchen. The facility does not prepare or cook food.

The center has shut down all faucets for water consumption within the mentioned classrooms and labeled "Do Not Use".

The facility will developed a Plan of Correction (POC) and email LPA. The facility's POC is currently set in place facility has immediately stopped using the water outlets. Also, the facility is working decided if water outlet will replacement and/or removing.

A Type B deficiency and plan of correction has documented and issued today, see LIC809D. This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation.

Exit interview was conducted with the Director, Elizabeth Villarreal.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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 04/26/2023 03:26 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 04/26/2023 at 03:20 PM
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: QUARRY LANE SCHOOL, THE
FACILITY NUMBER: 013411305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
101238(a)

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101238(a) Building and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well beling of children, employees and visitors.
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LPA Observed the facility has shut down the noted water fountains, each is completely covered with a "do not use" sign posted. The children are using personal water bottles that are being refilled as needed from kitchen and/or staff kitchen. Lead posted results are posted on the parent board.
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This requirement was not met as evidenced by: Based on observation and documentation of the Lead Testing Result, the faucet that exceeds the 5PPB level.
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Director will inform LPA if the facility will replace or removed the water outlets. The documentation must be submitted by May 26, 2023 via 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: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


LIC809 (FAS) - (06/04)
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