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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411745
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:18:57 PM

Document Has Been Signed on 05/19/2023 03:18 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:CHABOT COLLEGE, CHILDREN'S CENTERFACILITY NUMBER:
013411745
ADMINISTRATOR:ORTIZ, CARMENFACILITY TYPE:
850
ADDRESS:25555 HESPERIAN BOULEVARDTELEPHONE:
(510) 723-6684
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 120TOTAL ENROLLED CHILDREN: 37CENSUS: 32DATE:
05/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Carmen OrtizTIME COMPLETED:
03:15 PM
NARRATIVE
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On 5/19/2023 at 2:35pm, Licensing Program Analyst (LPA) Morgan Pringle conducted a case management inspection due to the center's lead testing results. LPA met with Director Carmen Ortiz. During LPA’s visit there were thirty-two (32) preschool age children, five (5) staff members and one (1) Chabot College student assistant.

The department was notified that two (2) water fountains located in the facility hallway have elevated lead levels that have exceeded 5.5 ppb. This exceeds the Action Level (ALE) established by the state for lead exposure. Per director Carmen Ortiz, these faucets were immediately closed off and will be replaced and retested. Director is working with Chabot College to determine a retesting date. LPA observed today the faucets are closed and not in use. LPA also observed posting of lead testing results.

See LIC809D for deficiencies cited during today's inspection.

Exit interview conducted with licensee Carmen Ortiz. A notice of site visit was provided and must be posted for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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 05/19/2023 03:18 PM - It Cannot Be Edited


Created By: Morgan Pringle On 05/19/2023 at 03:02 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: CHABOT COLLEGE, CHILDREN'S CENTER
FACILITY NUMBER: 013411745

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1)-Lead Testing Written Directive- A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE)
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LPA observed the 2 water outlets have been closed. Director is advised to submit re-test results to LPA by due date of 6/19/2023. If due date cannot be met Director is to contact LPA with an update.
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This requirement is not met as evidenced by: Based on record review, the facility has 2 outlets in the facility hallway that have an ALE of 5.5ppb or greater, which poses a potential health and safety risk to persons in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023


LIC809 (FAS) - (06/04)
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