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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013420528
Report Date:
05/19/2023
Date Signed:
05/19/2023 12:15:37 PM
Document Has Been Signed on
05/19/2023 12:15 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:
DR. HERBERT GUICE CHRISTIAN ACADEMY
FACILITY NUMBER:
013420528
ADMINISTRATOR:
ANGELA DARBY
FACILITY TYPE:
850
ADDRESS:
6925 INTERNATIONAL BLVD
TELEPHONE:
(510) 729-0330
CITY:
OAKLAND
STATE:
CA
ZIP CODE:
94621
CAPACITY:
57
TOTAL ENROLLED CHILDREN:
57
CENSUS:
12
DATE:
05/19/2023
TYPE OF VISIT:
Case Management - Lead Testing/Exceedance
UNANNOUNCED
TIME BEGAN:
09:50 AM
MET WITH:
Angela Darby
TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Diana Campos met with Director Angela Darby to conduct an unannounced
Case Management
inspection regarding a lead exceedance from a faucet in the center. The kitchen sink faucet identified as faucet (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 today's inspection were 13 children and 2 staff. Facility had a lead test completed on 4/16/2022.
LPA observed the faucet identified as faucet (D) as inoperable during the inspection. Director stated that faucet (D) has not been used for drinking or cooking since early 2020 and has been permanently shut off. Director stated facility plans to repair faucet pending grant approval. Director understands that the faucet (D) will need to be retested after completion of repairs. Faucet (D) will remain inoperable and not be used 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.
No deficiencies were cited at this time.
Exit interview and report reviewed with Angela Darby.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Diana Campos
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/19/2023
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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