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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206127
Report Date: 01/19/2024
Date Signed: 01/19/2024 11:21:07 AM


Document Has Been Signed on 01/19/2024 11:21 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:OUSD - YUK YAUFACILITY NUMBER:
010206127
ADMINISTRATOR:ADAMS AM/LAU PMFACILITY TYPE:
850
ADDRESS:291 - 10TH STREETTELEPHONE:
(510) 874-7759
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY:82CENSUS: 52DATE:
01/19/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Gina Deville/Lawrence GotancoTIME COMPLETED:
11:30 AM
NARRATIVE
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On 01/19/2024 at 8:45 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 designated Lead Teacher, Gina Deville and Site Principal, Lawrence Gotanco, to explain the purpose of today's visit. The licensee initially submitted results from lead testing that was conducted at the facility on 08/03/2022. During that time, 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 Faucet 1- Kitchen sink (See 809D). Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 were not deemed safe to drink. The Fauct 1- Kitchen sink was repaired and retested on 11/07/2023, which indicates there is no longer an exceedance at the facility. The facility has come back into compliance.

Exit interview conducted, appeal rights were given, and report was reviewed with the Site Principal,Lawrence Gotanco.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
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 01/19/2024 11:21 AM - 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 - YUK YAU
FACILITY NUMBER: 010206127

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2024
Section Cited
CCR
101700(b)(2)

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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 facility repaired and retested all outlets on 11/07/2023, which shows no exceedance at the facility.

The facility has come back into compliance.

POC cleared by visit.
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Based on interview and record review the licensee did not comply with the section cited above as Faucet 1- Kitchen Sink 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: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
LIC809 (FAS) - (06/04)
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