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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212832
Report Date: 12/21/2023
Date Signed: 12/21/2023 10:25:22 AM

Document Has Been Signed on 12/21/2023 10:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDS CARE PLUS - STANTONFACILITY NUMBER:
010212832
ADMINISTRATOR:LUDKE, DENISEFACILITY TYPE:
840
ADDRESS:2644 SOMERSET AVE. + PORTABLE.TELEPHONE:
(510) 733-0775
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 1DATE:
12/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annaleza RoqueTIME COMPLETED:
10:45 AM
NARRATIVE
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On 12/21/2023 at 9:00am, 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 recent lead testing performed. LPA met with Director, Annaleza Roque. Also present during today's inspection was 1 child and 1 staff.

A lead test completed for water locations intended for human consumption for faucets within the facility. On 10/17/2023, samples were collected from 2 faucets within the facility. 1 faucet, labeled "A" is a faucet sink and hand washing station in the classroom which test results showed a level of 6.10 ppb level of lead. A result of 5.5 ppb or greater is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction. The remaining 1 faucet that was tested had results either below 5.5 ppb or had no measurable level of lead detected, "Analyte Not Detected - ND".

A Plan of Correction has been discussed with the director and one of the following actions will be taken to remedy the issue:
1. The faucet on the sink to be replaced and a new sample will be conducted; or
2. The fountain will be permanently closed and removed

One Type B Deficiency was issued today with a plan of correction due date of 01/22/2024, see LIC 809D for additional information. A Notice of Site Visit was given and must be posted for 30 days. Appeal rights were given and reviewed. Exit interview conducted and report was reviewed with the director, Annaleza Roque.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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 12/21/2023 10:25 AM - It Cannot Be Edited


Created By: Christina Uribe On 12/21/2023 at 09:46 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: KIDS CARE PLUS - STANTON
FACILITY NUMBER: 010212832

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by:
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Director will either 1) have the faucet replaced and retested, or 2) permanently remove the faucet. This plan of correction has a due date of 01/22/2024. LPA Uribe will return to the facility after the due date to inspect the correction for compliance.
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One faucet sampled in the classroom tested with an Action Level Exceedance of 6.10 ppb.
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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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
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