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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213888
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:59:54 PM

Document Has Been Signed on 01/19/2023 03:59 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:BRIDGES COMMUNITY CHURCH - LITTLE LAMB MINISTRIESFACILITY NUMBER:
010213888
ADMINISTRATOR:AMY LEEFACILITY TYPE:
850
ADDRESS:505 DRISCOLL ROADTELEPHONE:
(510) 656-1359
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 12DATE:
01/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yueh-Yao TsaiTIME COMPLETED:
04:20 PM
NARRATIVE
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On January 19, 2022, License Program Analyst (LPA) Melanie Otsuji met with Director Yueh-Yao Tsai for an UNANNOUNCED CASE MANAGEMENT INSPECTION for Lead Testing Results. Present for today's inspection was the Director, 3 staff members and 12 preschool aged children. The facility operates Monday - Friday from 8:30AM - 6:00PM.

LPA and Director toured the facility and LPA obtained photos of the faucet that has exceeded 5.5 ppb. It was indicated that an area exceeded the Action Level established by the state for lead exposure. A Plan of correction was discussed with the Director. This facility is being given a TYPE B citation (see 809-D) The one faucet that exceeded the Action Level is faucet D. Faucet is located within an unoccupied classroom. Faucet has been placed off limits and will be removed.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Exit interview conducted and report was reviewed with the Director, Yueh-Yao Tsai.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/19/2023 03:59 PM - It Cannot Be Edited


Created By: Melanie Otsuji On 01/19/2023 at 03:02 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BRIDGES COMMUNITY CHURCH - LITTLE LAMB MINISTRIES
FACILITY NUMBER: 010213888

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1) Lead Testing Written Directive-
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Per Director, faucet has already been turned off to this spout. Director will have faucet removed as an immediate fix with the potential to be replaced in the future. Proof of removal of faucet to be submitted to LPA no later than 2/19/2023.
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This requirement is not met as evidenced by:
Based on record review, facility had 1 outlet of water test 5.5 ppb or greater (not used for drinking water/food preparation), which is 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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
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