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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420600
Report Date: 12/01/2023
Date Signed: 12/01/2023 01:22:10 PM

Document Has Been Signed on 12/01/2023 01:22 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:OUSD - SANKOFA UNITED PRESCHOOLFACILITY NUMBER:
013420600
ADMINISTRATOR:RODEZNO, LYNNEFACILITY TYPE:
850
ADDRESS:581 61ST STREETTELEPHONE:
(510) 639-3340
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 24TOTAL ENROLLED CHILDREN: 21CENSUS: 9DATE:
12/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Gaylynne HudsonTIME COMPLETED:
01:30 PM
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On 12/01/2023 at 12:45PM Licensing Program Analysts (LPAs,) A. Curry and B. Crass conducted an unannounced visit to follow up on a lead exceedance at the facility. LPAs met with Lead teacher, Gaylynne Hudson, 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 the drinking fountain, outlet 110923-4(C) . Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink (See 809D). The Lead Teacher indicated a bag was previously placed over the drinking fountain, but she was instructed by the elementary school to remove the bag due to it being a hazard. During today's visit the Lead Teacher placed another bag over the fountain and secured it with tape to ensure the fountain is inaccessible to children in care. The Lead Teacher stated she will place a "Do Not Use" sign next to the drinking fountain. The Lead Teacher has been advised to keep the bag placed over the drinking fountain until the fountain has been permanently removed or repaired and retested.

Exit interview conducted, appeal rights were given, and report was reviewed with the Lead Teacher, Gaylynne Hudson.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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 12/01/2023 01:22 PM - It Cannot Be Edited


Created By: Ashley Curry On 12/01/2023 at 01:00 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: OUSD - SANKOFA UNITED PRESCHOOL
FACILITY NUMBER: 013420600

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2024
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 was not met as evidence by:
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The Lead Teacher placed a bag over the drinking fountain and secured it with tape during the visit.

By 01/02/24 the facility will submit documentation that shows if the fountain was permanently removed or repaired and retested.
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Based on interview and record review the licensee did not comply with the section cited above as Outlet 110923-4(C) 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: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


LIC809 (FAS) - (06/04)
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