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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421979
Report Date: 09/07/2022
Date Signed: 09/07/2022 11:11:08 AM

Document Has Been Signed on 09/07/2022 11:11 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:VALLEY CHRISTIAN PRESCHOOLFACILITY NUMBER:
013421979
ADMINISTRATOR:JARIN, RINAFACILITY TYPE:
830
ADDRESS:7500 INSPIRATION DRTELEPHONE:
(925) 560-6235
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 9DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Director, Rina Jarin TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with Director Rina Jarin to conduct a Case Management inspection for the Lead Testing results at Valley Christian Preschool .In addition to the director, there are 9 children and 4 staff members present today. The facility operates Monday - Friday from 7:30am AM to 6:00 PM.

LPA conducted an inspections and Inspected the facility for health and safety. It was concluded that one of the outlets exceeded the Action Level that was established by the stated for exposure. LPA discussed a Plan of Correction and facility has submitted the documentation for the post-testing requirements.

The following deficiency is (See LIC 809-D.) cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Rina Jarin.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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 09/07/2022 11:11 AM - It Cannot Be Edited


Created By: Jyoti Saini On 09/07/2022 at 10:32 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: VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 013421979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by
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The facility has already devleoped the alternative plan to provide safe drininking to the children in care. LPA received a written directive stating that Children will bring water bottles from home. In addition, the facility will not be using the outlets and in the process of replacing/reparing the outlets.
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Based on Lead Testing Samples it was concluded that one of the outlets exceeded the Action Level that was established by the stated for exposure. This is an potential risk to Health and Safety or Personal Rights risk to persons in care.
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Since the facility has opt to repair/replace the water outlets, a follow up water sample shall be taken following the lead testing protocol.

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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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022


LIC809 (FAS) - (06/04)
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