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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420559
Report Date: 04/30/2024
Date Signed: 04/30/2024 11:17:02 AM

Document Has Been Signed on 04/30/2024 11:17 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO - GRANTFACILITY NUMBER:
013420559
ADMINISTRATOR/
DIRECTOR:		CLAY, ADRIENNEFACILITY TYPE:
850
ADDRESS:879 GRANT AVETELEPHONE:
(510) 901-1552
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
04/30/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:41 AM
MET WITH:Baoxian SituTIME VISIT/
INSPECTION COMPLETED:
12:03 PM
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Licensing Program Analyst (LPA) Sidney Cortez met with Director Baoxian Situ to conduct a Case Management inspection for the Lead Testing results at this facility. In addition to the director, 10 children and 3 staff members are present today. The facility operates Monday - Friday from 7:30 am to 4:00 pm.

LPA Inspected the facility for health and safety. It was concluded that based on the testing results there was no outlet that exceeded the Action Level. The lab who conducted the tests needed to upload the results on the WaterBoard portal. No plan of corrections needed.

LPA Cortez provided technical assistance to the new director (went over physical plants, incident reports, and personnel files, and children files).

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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