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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214758
Report Date: 01/16/2024
Date Signed: 01/16/2024 03:20:56 PM

Document Has Been Signed on 01/16/2024 03:20 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:BAY AREA CHILD CARE - GOMESFACILITY NUMBER:
010214758
ADMINISTRATOR:SIDDIGUI, SAYEEDAFACILITY TYPE:
840
ADDRESS:577 LEMOS LANETELEPHONE:
(510) 490-4222
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 10DATE:
01/16/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sayeeda SiddiguiTIME COMPLETED:
03:40 PM
NARRATIVE
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On 1/16/2024 Licensing Program Analyst (LPA) Melanie Otsuji conducted a Case Management - Lead Testing/Exceedance Inspection. LPA met with the Director, Sayeeda Siddigui. LPA was provided a tour of the facility inside and out. Also present during today's inspection were 2 additional staff members and 10 school aged children.

LPA discussed to the facility representative that 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. Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer procedures for lead testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act. LPA discussed to the facility representative of the PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370 https://cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21-CCP.pdf

Sample ID 010214758 A and B - had a Lead Action Level of Exceedance Response test date of 11/15/2023 of 5.5 ppb or greater. The facility representative stated they have not utilized the sink since testing results came in. Facility had outlet replaced and is awaiting retesting.

Please see LIC 809D page for the citation.

Appeal rights provided. Exit interview was conducted with Director, Sayeeda Siddigui and facility representative, Michele Massaro..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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 01/16/2024 03:20 PM - It Cannot Be Edited


Created By: Melanie Otsuji On 01/16/2024 at 02:48 PM
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: BAY AREA CHILD CARE - GOMES
FACILITY NUMBER: 010214758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited

101700.3(b)(2)

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 Lead Testing Written Directive- 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.This requirement is not being met as evidence by
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Facility has already replaced the outlet(s) identified with an Action Level Exeedance. Facility is to retest outlet and results to be forwarded to LPA no later than 2/16/2024 via email.
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This requirement is not met as evidenced by:
Based on record review, facility has A and B outlets of water test 5.5 ppb or greater, which is a potential health and safety risk to persons in care.
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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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
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