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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700748
Report Date: 03/26/2024
Date Signed: 03/26/2024 12:16:57 PM

Document Has Been Signed on 03/26/2024 12:16 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:COMMUNITY FIRST SCHOOLFACILITY NUMBER:
435700748
ADMINISTRATOR:TRAN, THAOFACILITY TYPE:
850
ADDRESS:1171 EAST CALAVERAS BOULEVARDTELEPHONE:
(408) 739-2022
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 24DATE:
03/26/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Thao TranTIME COMPLETED:
12:30 PM
NARRATIVE
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On 3/26/2024 at 10:50 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Thao Tran, and explained the nature of the visit. Present on this visit were Staff 7 and 24 preschool children. The facility operates from Monday to Friday 7am to 6 pm.

LPA discussed to the Director the PIN 21-21.1-CCP - WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS (CCC) Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

The facility had their drinking water outlets sampled dated on 1/13/24, analysis date 1/19/24 and three (3) drinking water outlet test results in an Action Level Exceedance (ALE). It was the Sink Faucet (E) in Preschool Room number 1, Sink Faucet (L) and (M) in Peschool Room number 4. The drinking water outlets mentioned were replaced today 3/26/2024. LPA inspected the mentioned drinking water outlets, obtained and reviewed the Service and Repair order document. Also, LPA obtained a copy of the Sign In Sheet for the day.

As a result of the (ALE), Type B deficiency cited during today's inspection and please see LIC 809 D.

Exit interview conducted and report was reviewed with the Director Thao Tran.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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 03/26/2024 12:16 PM - It Cannot Be Edited


Created By: Manel Estoesta On 03/26/2024 at 11:51 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: COMMUNITY FIRST SCHOOL
FACILITY NUMBER: 435700748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2024
Section Cited

100700.3(b)(2)

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Written Directives Section 100700.3 (b)(2) that states “Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.”
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The drinking water outlets mentioned were replaced today 3/26/2024. LPA inspected the mentioned drinking water outlets, obtained and reviewed the Service and Repair order document.
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Action Level Exceedance (ALE) of the Sink Faucet (E) in Preschool Room number 1, Sink Faucet (L) and (M) in Peschool Room number 4 which posed a potential health and safety risk to children in care.
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The Director will schedule retesting the water outlets and will inform the Regional Office as per the Written Directives.

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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:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024


LIC809 (FAS) - (06/04)
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