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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408915
Report Date: 12/08/2022
Date Signed: 12/08/2022 04:31:51 PM

Document Has Been Signed on 12/08/2022 04:31 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:LITTLE GENIUS ACADEMYFACILITY NUMBER:
073408915
ADMINISTRATOR:NIES, KRISTINAFACILITY TYPE:
850
ADDRESS:2131 OLYMPIC BOULEVARDTELEPHONE:
(925) 207-0329
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 117TOTAL ENROLLED CHILDREN: 66CENSUS: 59DATE:
12/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tamara ShekTIME COMPLETED:
03:00 PM
NARRATIVE
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On 12/8/22 at 2:00 pm Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts met with Licensee/Administrator, Tamara Shek to conduct a Case Management inspection for the Lead Testing results at Little Genius Academy.

LPAs conducted an inspection and toured the premises with Tamara Shek. It was indicated that there was at least one outlet that exceeded the Action Level established by the State for exposure. Tamara stated the outlet was used for drinking water located in the Pre-K building. They have replaced the outlet and will re-test it with an approved sampler. This posed a potential risk to health and safety of children in care.

Deficiency is cited from the California Code of Regulations, Title 22 (see 809D). Facility has submitted the documentation for the post-testing requirements and LPAs discussed a Plan of Correction moving forward.

Exit interview conducted and report was reviewed with Licensee, Tamara Shek. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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 12/08/2022 04:31 PM - It Cannot Be Edited


Created By: Monica Mathur On 12/08/2022 at 03:06 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: LITTLE GENIUS ACADEMY
FACILITY NUMBER: 073408915

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2023
Section Cited
CCR
101238(a)

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101238 Building & Grounds (a) The childcare center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by
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Licensee has submitted a written plan on steps that have been taken. Outlet has been replaced and schduled to be retested soont. They will been running the water for 3 wks and scheduled appointment to re-test as per directions by sampler.
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Based on Lead Testing Sample results the facility has at least 1 water faucet with lead exposure. This is a potential risk to Health and Safety or Personal Rights 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
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