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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402302
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:09:22 PM

Document Has Been Signed on 10/17/2023 02:09 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:ANGELS MONTESSORI PRESCHOOL - CONCORDFACILITY NUMBER:
073402302
ADMINISTRATOR:KARAMPOUR, ANGELFACILITY TYPE:
850
ADDRESS:1566 BAILEY ROADTELEPHONE:
(925) 686-5621
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 49TOTAL ENROLLED CHILDREN: 15CENSUS: 14DATE:
10/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maryam KarampourTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/17/23, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Randall Dunevant conducted an unannounced case management inspection, to follow up on test results received indicating a lead exceedance in two outlets. and LPA met with Angel Maryam Karampour. There were 14 children and 1 additional staff also present. There were 3 behavioral technicians also present.

The facility completed the required lead testing of water outlets and two outlets were found to be in exceedance of the Action Level of 5 ppb. One outlet is in a classroom that is currently not in use. The outlet in the classroom that is in use was made inaccessible to children. The facility posted the test results on the parent during the inspection. The facility plans to have the outlets replaced this weekend, flush the system and retest at the beginning of November. The facility understands that they are unable to use the two outlets until they receive the test results, and the Action Level is 5 ppb or below.

See LIC 809D for a deficiency being cited today. No other deficiencies are being cited today. An exit interview was conducted with Maryam Karampour, 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: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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 10/17/2023 02:09 PM - It Cannot Be Edited


Created By: Loretta Dyson On 10/17/2023 at 01:28 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: ANGELS MONTESSORI PRESCHOOL - CONCORD
FACILITY NUMBER: 073402302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
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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One outlet is in a classroom that is not currently in use. The second outlet inside of the classroom in use was made inaccessible to children. The facility is working on replacing the outlets, and will submit proof of the new test results, with Action Level at 5ppb or below, by 11/17/23.
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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 children in care.
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The facility will submit the test results once the outlets are retested, and understands not to use the outlets until the Action Level is determined to be 5 ppb or below.

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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: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023


LIC809 (FAS) - (06/04)
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