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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700612
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:03:22 PM

Document Has Been Signed on 05/08/2024 02:03 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:LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOLFACILITY NUMBER:
015700612
ADMINISTRATOR/
DIRECTOR:		LOCUS, LISAFACILITY TYPE:
830
ADDRESS:348 NORTH CANYONS PARKWAYTELEPHONE:
(408) 431-9226
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 51TOTAL ENROLLED CHILDREN: 27CENSUS: 22DATE:
05/08/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Abadat KhanTIME VISIT/
INSPECTION COMPLETED:
02:02 PM
NARRATIVE
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On 5/8/2024 at 1:00pm, Licensing Program Analyst (LPA) Morgan Pringle conducted a case management inspection due to the center's lead testing results. The facility is located on the left side of the Cornerstone Fellowship Church. LPA met with Director Abadat (Abi) Khan and Director of Operations Bertha Bryan. There were twenty-two (22) infants and eight (8) additional staff present. The facility operates from 7:00am - 6:00pm, Monday - Friday.

The department was notified that one (1) water faucet located in The Toddler room (Orange Room) had elevated lead levels that have exceeded 5.5 ppb. This exceeded the Action Level (ALE) established by the state for lead exposure.

The facility requires all children to bring their own water bottles and uses water from the kitchen to refill the bottles. Once the facility was notified of the exceedance postage was installed to not use the faucet and the faucet was made inaccessible to the children in care. Facility has replaced the faucet and is in the process of having it retested. Director is aware that the faucet may not be used until it is retested and tests below the minimum 5.5 ppb that is required.

See LIC809D for Type B deficiency cited during today's inspection.

Exit interview conducted with Director Abadat Khan. 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: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 05/08/2024 02:03 PM - It Cannot Be Edited


Created By: Morgan Pringle On 05/08/2024 at 01:43 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: LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOL
FACILITY NUMBER: 015700612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2024
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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The faucet in Toddler Room (Orange Room) that had exceeded lead levels was replaced. Facility will retest the faucent and send LPA Pringle the results upon receipt of retest.
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This requirement is not met as evidenced by: Based on record review, the facility had 1 outlet in the Toddler Room (Orange) that had an ALE of 5.5ppb or greater which poses a potential health and safety risk to 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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


LIC809 (FAS) - (06/04)
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