<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200115
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:46:53 PM


Document Has Been Signed on 04/14/2023 04:46 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:CHILDRENS COMMUNITY CENTERFACILITY NUMBER:
010200115
ADMINISTRATOR:KATHY CHEWFACILITY TYPE:
850
ADDRESS:1140 WALNUT STTELEPHONE:
(510) 528-6975
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY:52CENSUS: 43DATE:
04/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Allyssa AdairTIME COMPLETED:
04:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 14, 2023 at 10:47am Licensing Program Analyst (LPA) Indira Loza met with Co-Director/Teacher Allyssa Adair to conduct an unannounced case management inspection regarding a lead exceedance from a drinking fountain in the center. The water supply located on the backside of the the "Backyard Classroom" 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.

LPA observed the faucet (Site G) inoperable to children in care. The faucet labeled "Site G" must either be permanently disabled or will remain inoperable and not be used until the facility is notified that the amount of lead in the water supply is acceptable. If the Licensee chooses not to permanently disable the fountain then they shall contact the water sampler agency to schedule an appointment and submit results by May 26, 2023. The Director is advised to email LPA with a date of when the results will are ready.

See 809-D for deficiency.

Exit interview conducted.
Report and Appeal Rights provided to Teacher Encian Pastel.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/14/2023 04:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: CHILDRENS COMMUNITY CENTER
FACILITY NUMBER: 010200115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited

1
2
3
4
5
6
7
Lead Testing Written Directive
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
The facility will permanently disable or repair the faucet and retest to ensure children are safe to use the faucet. Director shall send LPA updated results by May 26, 2023.
8
9
10
11
12
13
14
Based on record review the licensee did not comply with the section cited above as there was a faucet used by children that had a lead exceedance, which poses a potential Health and Safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2