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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214382
Report Date: 04/06/2023
Date Signed: 04/06/2023 05:24:11 PM


Document Has Been Signed on 04/06/2023 05:24 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:RENAISSANCE INTERNATIONAL SCHOOL, THEFACILITY NUMBER:
010214382
ADMINISTRATOR:HITES, LESLIEFACILITY TYPE:
850
ADDRESS:3650 DIMOND AVE.TELEPHONE:
(510) 531-8566
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:150CENSUS: 26DATE:
04/06/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
04:14 PM
MET WITH:Leslie HitesTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Cherie Acosta and Diana Campos met with Director Leslie Hites to conduct an unannounced case management inspection regarding a lead exceedance from a faucet in the center. The Sequoia classroom faucet identified as faucet L 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 identified as faucet L as inoperable during the inspection. Director stated that faucet L has been replaced and will be retested. The facility was directed to run the water 4 times a day for 30 seconds for a total of 3 weeks before retesting the water supply. Faucet L will remain inoperable and not be used until the facility is notified that the amount of lead in the water supply is acceptable. The facility will contact the water sampler agency to schedule an appointment for re-testing.

See 809-D for deficiency.

Exit interview and report reviewed with Leslie Hites
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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 04/06/2023 05:24 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: RENAISSANCE INTERNATIONAL SCHOOL, THE
FACILITY NUMBER: 010214382

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2023
Section Cited

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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:
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Faucet identified as faucet L has been replaced and has been made inoperable. The citation is cleared during today's visit.
The facility will schedule a re-test of faucet L and notify LPA of the scheduled test date by 5/5/23
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Based on record review a faucet at the facility (identified as faucet L) used by children had a lead exceedance, which poses a potential risk to the health and safety of children 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 JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
LIC809 (FAS) - (06/04)
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