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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411214
Report Date: 08/31/2023
Date Signed: 08/31/2023 09:41:39 AM


Document Has Been Signed on 08/31/2023 09:41 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:KIDANGO-GLEN BERRY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013411214
ADMINISTRATOR:DONUELL LILLYFACILITY TYPE:
850
ADDRESS:625 BERRY AVENUETELEPHONE:
(510) 907-1542
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:32CENSUS: 14DATE:
08/31/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ebony JohnsonTIME COMPLETED:
09:30 AM
NARRATIVE
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On August 31, 2023 at 8:30 AM., Licensing Program Analyst (LPA) Elimika Woods conducted a Case Management inspection due to the center's lead testing results. LPA met with the facility representative, Ebony Johnson. There were 14 preschool age children and three additional staff member present for the inspection.

LPA discussed with the Director that Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer procedures for lead testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act. LPA discussed with the Director of the PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370 https://cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21-CCP.pdf

Sample ID B - Sink Faucet_location had a Lead Action Level of Exceedance Response of more than 5.5ppb. The Director stated that Re-testing has been completed on 8/17/23. LPA confirmed the Plan of Correction with the facility representative.

See LIC 809-D for deficiencies cited during today's inspection. LPA generated a Proof of Correction Clearance Letter and provided a copy to the Director.

Appeal rights provided. Exit interview was conducted with the facility representative Ebony Johnson. A notice of site visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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 08/31/2023 09:41 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDANGO-GLEN BERRY CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013411214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2023
Section Cited

101238.(a)

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101238(a) Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.....
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LPA confirmed the Plan of Correction (retest results provided on 8/17/23).
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Sample ID b - Sink Fauce had a Lead Action Level of Exceedance Response of more than 5.5ppb. This poses a potential health, safety and personal rights risk to 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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
LIC809 (FAS) - (06/04)
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