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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404440
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:31:53 PM

Document Has Been Signed on 09/28/2022 04:31 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CONTRA COSTA CO. CSD - GEORGE MILLER IIICH.CENTERFACILITY NUMBER:
073404440
ADMINISTRATOR:VILLARPANDO, KARLAFACILITY TYPE:
850
ADDRESS:300 S. 27TH STREETTELEPHONE:
(510) 374-3526
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 200TOTAL ENROLLED CHILDREN: 200CENSUS: 9DATE:
09/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Ruth HunterTIME COMPLETED:
04:45 PM
NARRATIVE
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On Wednesday, September 28, 2022 at 2:55 PM, Licensing Program Analyst (LPA) Caroline Colson met with Ruth Hunter, Site Supervisor Ill, and Karla Villarpando, Center Director for an unannounced case management inspection for Lead Testing Results. There are 9 preschool children and 4 staff members including the director. The facility received their Lead Test Results which included 10 faucets in 4 classrooms. Test Results and Facility Sketches were received.

Please See LIC 809 D for Deficiency

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Ruth Hunter, Site Supervisor lll.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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 09/28/2022 04:31 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/28/2022 at 03:41 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: CONTRA COSTA CO. CSD - GEORGE MILLER IIICH.CENTER
FACILITY NUMBER: 073404440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
101700.3(b)(1)

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Lead Testing Written Directive
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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BY POC DUE DATE: Licensee will will repair all faucets and retest to ensure children are safe to use these faucets. Room 4, Room 5 and Room 9 are temporary closed at this time.
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Based on record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.

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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


LIC809 (FAS) - (06/04)
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