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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419409
Report Date: 10/17/2023
Date Signed: 10/17/2023 03:02:19 PM

Document Has Been Signed on 10/17/2023 03:02 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:SUPPORTING FUTURE GROWTH - SITE IIIFACILITY NUMBER:
013419409
ADMINISTRATOR:AKINTOMIDE, KYMFACILITY TYPE:
850
ADDRESS:6865 LEONA CREEK DRIVE, # 102TELEPHONE:
(510) 636-1732
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 10DATE:
10/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yu Yun GuanTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Diana Campos met with Center Director Yu Yun Guan to conduct an unannounced case management inspection regarding lead exceedance from four faucets in the Preschool center. The faucets identified as faucet A, B, C and D 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 4 staff and 10 children in care.

LPA observed the faucets identified as faucet A, B, C and D as inoperable for drinking or cooking during the inspection. Director stated that faucets are in the process of being replaced and retested and currently not in use. The facility is waiting for approval to hire a plumber to replace faucets. All four faucets labeled A, B, C, and D will remain inoperable and not be used for drinking or cooking until the facility is notified that the amount of lead in the water supply is acceptable. The facility will contact the water sampler agency to schedule an appointment for re-testing after all faucets are replaced.

See 809-D for deficiency.

Exit interview and report reviewed with Director Yu Yun Guan.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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 10/17/2023 03:02 PM - It Cannot Be Edited


Created By: Diana Campos On 10/17/2023 at 02:34 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: SUPPORTING FUTURE GROWTH - SITE III
FACILITY NUMBER: 013419409

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
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 A, B, C, and D are currently inoperable for drinking and cooking. Director shall submit a plan of action on when the faucets will be replaced and retested and follow up with results after retesting is completed.
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Based on record review four faucets at the facility (identified as faucets A, B, C, and D 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: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023


LIC809 (FAS) - (06/04)
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