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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440703706
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:10:41 PM

Document Has Been Signed on 08/17/2023 12:10 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FREEDOM CHILDREN'S CENTERFACILITY NUMBER:
440703706
ADMINISTRATOR:MARIA FERNANDEZFACILITY TYPE:
850
ADDRESS:37 HOLLY DRIVETELEPHONE:
(831) 786-2300
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY: 64TOTAL ENROLLED CHILDREN: 23CENSUS: 18DATE:
08/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Vanessa GarciaTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Child Development Coordinator, Vanessa Garcia, and explained purpose of visit- to follow-up on water lead testing conducted for the facility. LPA was admitted into the facility by Site Director, Maria "Lupe" Fernandez, and requested Vanessa identify faucet with Action Level Exceedance (value of 5.5 parts per billion or greater).

LPA received the following documents via email from Vanessa on 8/10/2023: Self-Certification (LIC9275) completed by Certified External Water Sampler, Sampling Checklist Form (LIC9276), and Facility Sketch (LIC999) labeled with locations of water outlets. Paper copies of the documents were additionally provided to the LPA during todays inspection.

Water sample was conducted by Central Coast Lead Inspection Services on 7/26/2023 and the report indicated that faucet "F" had Action Level Exceedance value of 5.8. The faucet is located in the kitchen and is one of the faucets for the dish washing sink. The facility has remediated faucet "F" by fully replacing faucet on 8/8/2023 and it is currently made inaccessible until water lead testing is redone. Vanessa states that the facility is completing 30 second flushes four times per day for 21 days on faucet "F" until retesting can be done. LPA observed that the faucet has a bag covering the end of the faucet, so it will not be used. Vanessa states that the faucet will be retested and she will submit retesting results to Licensing upon completion. The date for retesting is currently unknown, however Vanessa states that she estimates it will be completed sometime in early September. LPA requested that Vanessa let Licensing know when she has a confirmed date for the faucet retesting.

Exit interview conducted and report was reviewed with the Child Development Coordinator, Vanessa Garcia.

As a result of todays inspection, a deficiency was cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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 08/17/2023 12:10 PM - It Cannot Be Edited


Created By: Cortney Nelson On 08/17/2023 at 11:52 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FREEDOM CHILDREN'S CENTER
FACILITY NUMBER: 440703706

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives (b)(1) a result with values of 5.5 parts per billion or greater shall be deemed an Action Level Exceedance (ALE).

This requirement was not met as evidenced by:
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The facility has completely replaced faucet "F" and is planning to get it rested to confirm that replacing the faucet has resolved the water lead ALE result.
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After water lead testing was completed, the facility had one faucet (F) located in the kitchen with an Action Level Exceedance of 5.8, which poses a potential risk to the health, safety, and personal rights of children in care.
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The facility will notify Licensing when the restesting has been scheduled for faucet "F" and will submit water lead testing results when completed. The faucet will remain inaccessible to children until retesting completed.

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


LIC809 (FAS) - (06/04)
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