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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206037
Report Date: 07/17/2023
Date Signed: 07/17/2023 01:00:54 PM


Document Has Been Signed on 07/17/2023 01:00 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 - BELLA VISTAFACILITY NUMBER:
010206037
ADMINISTRATOR:ASENSIOSMENDOZA, OFELIAFACILITY TYPE:
850
ADDRESS:2410- 10TH AVENUETELEPHONE:
(510) 879-1657
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY:64CENSUS: 30DATE:
07/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Alesia EutslerTIME COMPLETED:
02:30 PM
NARRATIVE
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On 07/17/2023 at 11:45 AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management inspection to follow up on a lead exceedance at the facility. LPA met with Site Principal, Alesia Eutsler, to explain the purpose of today's inspection. 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 outlets labeled Library Sink 1 BLDG 2 and Bubbler BLDG 6 sink 1. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink (See 809D). During today's visit, LPA verified the two water fountains were placed offline and made inoperable. The licensee was advised to place a sign next to each faucet that indicates it is not to be used.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
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 07/17/2023 01:00 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: OUSD - BELLA VISTA
FACILITY NUMBER: 010206037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2023
Section Cited
CCR
100700.3

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Licensee shall maintain a lead value at or below the Action Level of 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 facility placed both outlets offline and made them inoperable.

By 08/18/2023 LPA will follow up with the facility to see if the fixtures will be repaired or permanently removed.
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Based on record review the licensee did not comply with the section cited above as outlets Library Sink 1 BLDG 2 and Bubbler BLDG 6 Sink 1 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 DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
LIC809 (FAS) - (06/04)
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