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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422409
Report Date: 05/15/2024
Date Signed: 05/15/2024 03:53:14 PM

Document Has Been Signed on 05/15/2024 03:53 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:LEARN AND PLAY MONTESSORI SILVERGATE, INC.FACILITY NUMBER:
013422409
ADMINISTRATOR/
DIRECTOR:		PANGANAMALA, NEERAJAFACILITY TYPE:
850
ADDRESS:11900 SILVERGATE DRIVETELEPHONE:
(925) 248-2200
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 92DATE:
05/15/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH: Director,Neeraja Panganamala, and Senior director, Natasha Aguilar. TIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Jyoti Saini visited the facility unannounced and conducted a Case Management visit to discuss recent lead testing results. The LPA met with the Director, Neeraja Panganamala, and senior director, Natasha Aguilar.

On 10/20/2022, samples were collected from 11 faucets within the facility. Out of 11 faucets, one sink(the center sink in restroom 104) was recorded as Action Level Exceedancee. The test results showed a 9.7 ppb level of lead. Though this faucet with an ALE was never used for drinking or food preparation by the facility, the facility decided to remediate it prior to CCLD intervention. The facility has already replaced and retested the water outlet to correct the exceedance. LPA obtained the retesting results of the samples collected on 5/10/2024.

A Type B Deficiency was issued today; see LIC 809D and the citation was cleared during the inspection.

A Notice of Site Visit was given and must be posted for 30 days.

Appeal rights were given and reviewed.

An exit interview was conducted, and the report was reviewed with the director,Neeraja Panganamala, and senior director,Natasha Aguilar.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 05/15/2024 03:53 PM - It Cannot Be Edited


Created By: Jyoti Saini On 05/15/2024 at 03:22 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: LEARN AND PLAY MONTESSORI SILVERGATE, INC.
FACILITY NUMBER: 013422409

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2024
Section Cited

101.700.3(B)(1)

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101700.3(b)(1)A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement is not met as evidenced by:
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The facility has already replaced and retested the outlet. The POC was cleared during the inspection.
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Based on observations, interviews, and record reviews, the facility did not comply with the section cited above. Licensee failed to maintain a lead value at or below the Action Level for water lead testing with values of 5.5 ppb or greater for center sink in the restroom 104, 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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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