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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211775
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:09:37 PM

Document Has Been Signed on 03/03/2023 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:HIS GROWING GROVEFACILITY NUMBER:
010211775
ADMINISTRATOR:JENNIFER YOUNGBLOODFACILITY TYPE:
850
ADDRESS:2490 GROVE WAYTELEPHONE:
(510) 581-5088
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 126TOTAL ENROLLED CHILDREN: 73CENSUS: 60DATE:
03/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer YoungbloodTIME COMPLETED:
02:45 PM
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On 03/03/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced visit to the facility for the purpose of a Case Management visit to discuss the results of lead testing performed. LPA met with Director, Jennifer Youngblood. Also present during today's inspection was 60 children and 11 staff.

A lead test was completed for water locations intended for human consumption for faucets within the facility. On 02/26/2022, samples were collected from 21 faucets within the facility. 1 faucet, labeled "CC-Drinking Fountain_Rm 7" was an indoor drinking fountain in Room 7 which test results showed a level of 19 ppb level of lead. A result of 5.5 ppb or greater is deemed an Action Level Exceedance (ALE) and required action for correction. The remaining 20 faucets that were tested had results either below 5.5 ppb or had no measurable level of lead detected, "Analyte Not Detected - ND".

The classroom (Room 7) which the faucet with an ALE is located in has been out of use and inaccessible to children in care since at least December 2019. As a result, this faucet has not been used for any purposes, including human consumption or food preparation, since that time.

To correct the exceedance after receiving the test results on 03/08/2022, the facility has already removed the drinking fountain from the sink. Additionally, the water access to the entire sink has been turned off since it is not in use. LPA Uribe took photos of the sink and the classroom for documentation.

A Notice of Site Visit was given and must be posted for 30 days. Exit interview conducted and report was reviewed with the director, Jennifer Youngblood.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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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