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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070208839
Report Date: 12/21/2022
Date Signed: 12/21/2022 01:10:23 PM

Document Has Been Signed on 12/21/2022 01:10 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:DIABLO VALLEY MONTESSORI SCHOOLFACILITY NUMBER:
070208839
ADMINISTRATOR:SUZETTE SMITHFACILITY TYPE:
850
ADDRESS:3390 DEERHILL ROADTELEPHONE:
(925) 283-6036
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 138TOTAL ENROLLED CHILDREN: 103CENSUS: 19DATE:
12/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jayne MartinTIME COMPLETED:
01:30 PM
NARRATIVE
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On 12/21/22 Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts met with Director, Jayne Martin to conduct a Case Management inspection for the Lead Testing results at Center.

LPA conducted an inspection and toured the premises with Director. Facility had reported lead exceedence on their Infant license # 070213379 located in the same premises. However, during inspection of both infant and preschool premises, it was determined the drinking water fountain that had lead exceedence was located in the outdoor playground on the preschool premises. Infant program does not have any exceedence. Director states children used the fountain for drinking water until March 2020, but closed it off when COVID started. Since children used the faucet for drinking water while there was lead exceedence, it posed a potential risk to health and safety of children in care.

Deficiency is cited from the California Code of Regulations, Title 22 (see 809D). LPAs observed the outlet has been permanently removed. Deficiency was cleared during the inspection and Letter of Clearance provided. Facility has submitted documentation for the post-testing requirements.

Exit interview conducted and report was reviewed with the Director, Jayne Martin. A Notice of Site Visit was given and must remain posted for 30 days

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/21/2022 01:10 PM - It Cannot Be Edited


Created By: Monica Mathur On 12/21/2022 at 10:46 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DIABLO VALLEY MONTESSORI SCHOOL
FACILITY NUMBER: 070208839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a) The childcare 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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LPA observed water fountain has been permanently removed since test result. Deficiency was cleared during inspection and Letter of Clearance provided.
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Based on Lead Testing Sample results the facility has one outdoor water fountain with lead exposure. Director stated children used it for drinking water until March 2020 and not been used since then. Since children were exposed to water with lead, this posed a potential risk to Health and Safety.
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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