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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422016
Report Date: 11/02/2023
Date Signed: 11/02/2023 06:09:19 PM

Document Has Been Signed on 11/02/2023 06:09 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LA PLAZITA PRESCHOOL IIFACILITY NUMBER:
013422016
ADMINISTRATOR:YALIN MILLER MORALESFACILITY TYPE:
850
ADDRESS:3625 MACARTHUR BLVDTELEPHONE:
(510) 566-5007
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 22DATE:
11/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
04:35 PM
MET WITH:Etelvina (Lupe) LopezTIME COMPLETED:
06:15 PM
NARRATIVE
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On 11/2/23 at 4:35pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the center for an unannounced case management inspection to follow up on results received indicating a lead exceedance for outlets at the facility. LPM met with Etelvina (Lupe) Lopez. There were 22 children and 6 additional staff also present.

The facility completed the required lead testing of water outlets in the facility. Two outlets were found to be in exceedance of the Action Level of 5 ppb. One outlet is inside of the children's bathroom in the Rojo/Amarillo room, and the second outlet is inside of the staff bathroom. Etelvina (Lupe) Lopez stated that both sinks have only ever been used for hand washing. The facility placed signs at the two sinks to remind children and staff to continue to only use the sinks for hand washing. LPM inspected the two sinks and verified that the signs have been placed. The facility completed and submitted all required documents to Community Care Licensing and posted the test results in the facility.

See LIC 809D for a deficiency being cited today. An exit interview was conducted with Etelvina (Lupe) Lopez, and a copy of this report, Notice of Site Visit, and appeal rights were emailed to the facility. The facility was reminded to have the Notice of Site Visit posted for 30 days.

SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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 11/02/2023 06:09 PM - It Cannot Be Edited


Created By: Loretta Dyson On 11/02/2023 at 05:12 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LA PLAZITA PRESCHOOL II
FACILITY NUMBER: 013422016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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The facility will either remove, or replace and retest, the sinks that have tested in exceedance of the allowed by 12/1/23.
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This requirement has not been met as evidenced by the lead testing results received, indicating that two outlets in the facility had results in exceedance of the 5 ppb Action Level. This poses a potential risk to the health and safety of children 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:Diane Perez
LICENSING EVALUATOR NAME:Loretta Dyson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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