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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417305
Report Date: 04/28/2023
Date Signed: 04/28/2023 03:21:59 PM

Document Has Been Signed on 04/28/2023 03:21 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:S.S.U.C. - DE COLORES HEADSTART & EARLY HEADSTARTFACILITY NUMBER:
013417305
ADMINISTRATOR:MICHELLE FREEMANFACILITY TYPE:
850
ADDRESS:1155 - 35TH AVENUETELEPHONE:
(510) 535-6106
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 134TOTAL ENROLLED CHILDREN: 95CENSUS: 67DATE:
04/28/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ana Maria BapistaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Diana Campos met with Center Director Ana Maria Baptista to conduct an unannounced case management inspection regarding lead exceedances from two faucets in the preschool center. Classroom 3 faucet identified as faucet W-2 and fountain identified as W-1. Classroom 4 faucet identified as W-3 and fountain identified as W-4 exceeded the acceptable amount of lead allowed in a child care center. During the unannounced inspection LPA toured the facility for a health and safety check. Present during the inspection were 15 staff and 67 children in care.

LPA observed the faucets identified as faucet W-1, and fountain W-2 in classroom 3 were replaced and retested. Faucet identified as W-3 and fountain W-4 were also replaced and retested. Results for both were determined to be below the designated action level (AL) of 5 PPB. Both classroom sinks are now operable for drinking or cooking during the inspection. Director stated that all faucets W-2, W-1, W-3, and W-4 have been replaced and retested. Corrections have been complete and deficiency cleared during today's inspection.

See 809-D for deficiency.

Exit interview and report reviewed with Center Director Ana Maria Baptista.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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 04/28/2023 03:21 PM - It Cannot Be Edited


Created By: Diana Campos On 04/28/2023 at 03:10 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: S.S.U.C. - DE COLORES HEADSTART & EARLY HEADSTART
FACILITY NUMBER: 013417305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2023
Section Cited

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. This requirement has not been met as evidenced by:
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Faucets identified as faucet W-1, W-2, W-3, and W-4 have been replaced and retested and are now operable for drinking and cooking. The citation is cleared during today's visit.
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Based on record review four faucets at the facility (identified as faucets W-1, W-2, W-3, and W-4) used by children had a lead exceedance, which poses a potential risk to the health and safety of children 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
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