<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214911
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:11:40 PM


Document Has Been Signed on 02/14/2023 12:11 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:KIDANGO-DELAINE EASTIN CHILD DEV. CENTERFACILITY NUMBER:
010214911
ADMINISTRATOR:HARDY, PETERFACILITY TYPE:
850
ADDRESS:584 BROWN ROADTELEPHONE:
(510) 490-5570
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:34CENSUS: 28DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica WeimarTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 14, 2023, License Program Analyst (LPA) Melanie Otsuji met with Facility Representative, Jessica Weimar, for an UNANNOUNCED CASE MANAGEMENT INSPECTION for Lead Testing Results. Also present for today's visit were 4 additional staff members and 28 preschool aged children. The facility operates Monday - Friday from 7:30AM - 5:30PM.

LPA 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 facility representative. This facility is being given a TYPE B citation (see 809-D) The one faucet that exceeded the Action Level is play yard faucet. Faucet is located on the outside play yard. Faucet has been placed off limits and will be repaired.

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 Facility Representative, Jessica Weimar.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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 02/14/2023 12:11 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 STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDANGO-DELAINE EASTIN CHILD DEV. CENTER
FACILITY NUMBER: 010214911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2023
Section Cited

1
2
3
4
5
6
7
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.
1
2
3
4
5
6
7
Per facility representative, faucet has already been turned off to this spout. Facility will have faucet repaired/replaced. Proof of repair to be submitted to LPA no later than 3/14/2023.

Because spout is going to be repaired/replaced, faucet will need to be re-tested.
8
9
10
11
12
13
14
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.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2