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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200356
Report Date: 11/16/2022
Date Signed: 11/16/2022 12:00:10 PM

Document Has Been Signed on 11/16/2022 12:00 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:KIDDIE KAMPUS COOPERATIVE PLAY SCHOOLFACILITY NUMBER:
010200356
ADMINISTRATOR:CARNAHAN, MICHELLEFACILITY TYPE:
850
ADDRESS:1711 - 2ND STREETTELEPHONE:
(510) 521-1218
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
11/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michelle Carnahan and Lori WhittockTIME COMPLETED:
12:05 PM
NARRATIVE
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On 11/16/2022 LPA Licensing Program Analyst (LPA) Arminder Singh met with Director, Michelle Carnahan and Assistant Director, Lori Whittock. for an unannounced case management inspection for Lead Testing Results. There are 18 children with two teachers, and four parents.

The facility received their Lead Test Results which includes 1 faucet. The faucet in the kitchen lead test results exceeded the allowed amount.


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 Director and Assistant Director.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/16/2022 12:00 PM - It Cannot Be Edited


Created By: Arminder Singh On 11/16/2022 at 11:42 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: KIDDIE KAMPUS COOPERATIVE PLAY SCHOOL
FACILITY NUMBER: 010200356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
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 faucet and retest to ensure children are safe to use faucet. Children will also bring own water bottles from home.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Arminder Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


LIC809 (FAS) - (06/04)
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