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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420549
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:51:25 PM

Document Has Been Signed on 11/16/2023 01:51 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:ALBANY CHILDREN'S CENTERFACILITY NUMBER:
013420549
ADMINISTRATOR:MANSKER, ANNAFACILITY TYPE:
850
ADDRESS:720 JACKSON STREETTELEPHONE:
(510) 559-6590
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: DATE:
11/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Joshua ReedTIME COMPLETED:
02:00 PM
NARRATIVE
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On 11/16/2023 at 9:15AM Licensing Program Analyst (LPA), A. Curry arrived at the facility to conduct an unannounced visit to follow up regarding a lead exceedance. LPA met with the Director, Joshua Reed, to explain the purpose of today's visit. The licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5ppb or greater for outlet H. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink (See 809D). The director indicated Outlet H has been replaced and the Director was advised to retest the outlet prior to the outlet being used for children to ensure the outlet no longer exceeds the allowed amount. During the visit the Director made the sink inaccessible by placing a bag over the outlet to ensure the outlet is not being used.


Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Joshua Reed.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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 11/16/2023 01:51 PM - It Cannot Be Edited


Created By: Ashley Curry On 11/16/2023 at 11:12 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALBANY CHILDREN'S CENTER
FACILITY NUMBER: 013420549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
101700.3

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Licensee shall maintain a lead value at or below the Action Level of 5.5 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 met as evidence by:
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The director has indicated the fixture been repair but was not resteted. A bag was placed over the outlet until outlet is retested and does not exceed.
By 12/15/2023 the facility submit proof that Outlet H was permanently removed or retested.
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Based on interview and record review the licensee did not comply with the section cited above as outlet H exceeded the acceptable amount of lead allowed in a child care center, which poses 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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


LIC809 (FAS) - (06/04)
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