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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214881
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:30:31 PM


Document Has Been Signed on 01/11/2023 02:30 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:BUSD - HOPKINS STREETFACILITY NUMBER:
010214881
ADMINISTRATOR:ROBINSON, K & CARRIEDO, M.FACILITY TYPE:
850
ADDRESS:1810 HOPKINS STREETTELEPHONE:
(510) 644-8939
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY:140CENSUS: 41DATE:
01/11/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Maria CarriedoTIME COMPLETED:
02:35 PM
NARRATIVE
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On January 11, 2023 at 1:29pm Licensing Program Analyst (LPA) Indira Loza met with Principal Maria Carriedo to conduct an unannounced case management inspection regarding a lead exceedance from a faucet in the center. The water supply in "Classroom 5" 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 I) in Classroom 5 to be inoperable and inaccessible to children in care. The Principal stated the school district's plumber will repair the faucet in Mid-January. 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. The faucet in Classroom 5 - "Site I" 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 by February 10, 2022. Principal Carriedo 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 Principal Carriedo.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
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 01/11/2023 02:30 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: BUSD - HOPKINS STREET
FACILITY NUMBER: 010214881

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
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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The facility will repair the faucet and retest to ensure children are safe to use the faucet. Principal shall send LPA updated results by February 10, 2023.
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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.
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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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2