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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418191
Report Date: 06/30/2023
Date Signed: 06/30/2023 01:29:53 PM


Document Has Been Signed on 06/30/2023 01:29 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:ESCUELA BILINGUE INTERNACIONALFACILITY NUMBER:
013418191
ADMINISTRATOR:JENNIFER GALLOSOFACILITY TYPE:
850
ADDRESS:410 ALCATRAZ AVETELEPHONE:
(510) 653-3324
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:105CENSUS: 21DATE:
06/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alejandra BarajasTIME COMPLETED:
03:00 PM
NARRATIVE
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On 06/30/2023 Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management inspection to follow up regarding the lead testing at the facility. LPA met with the campus coordinator, Alejandra Barajas, to explain the purpose of today's visit. During the visit the LPA was informed the facility did not have the drinking water tested for lead contamination (See 809D). Staff indicated the testing will be completed on 07/12/2023.

The Facility Representative was advised to review PIN 21-21.1-CCP for more information on lead testing of water for Child care Centers.

Exit interview conducted, appeal rights were given, and report was reviewed with Facility Representative Alejandra Barajas and Talia Romero via telephone.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023
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 06/30/2023 01:29 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: ESCUELA BILINGUE INTERNACIONAL
FACILITY NUMBER: 013418191

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
HSC
1596.16(a)(1)

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(1) A licensed child day care center... constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.
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By 07/28/2023 submit confirmation of appointment with a certified water sampler.

The facility cleared the POC during the visit by showing confirmation of appointment scheduled for 07/12/2023. LPA will follow up with facility after testing is completed.
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This requirement is not met as evidence by:
Based on interview and record review the facility did not comply with the section cited above by having the drinking water tested for lead contamination no later than 01/01/2023.
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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023
LIC809 (FAS) - (06/04)
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