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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420589
Report Date: 12/15/2022
Date Signed: 12/15/2022 10:03:35 AM


Document Has Been Signed on 12/15/2022 10:03 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013420589
ADMINISTRATOR:HUNT, VIRGINIAFACILITY TYPE:
850
ADDRESS:500 PACIFIC AVENUETELEPHONE:
(510) 748-4001
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:120CENSUS: 67DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Virginia HuntTIME COMPLETED:
10:30 AM
NARRATIVE
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On 12/15/2022 Licensing Program Analyst (LPA) Arminder Singh met with Director, Virginia Hunt for an unannounced case management inspection for Lead Testing Results. There are 67 children present today.

The facility received their Lead Test Results which includes 2 drinking fountains in two of the classroom. (Room 4 and Room 13) which exceeds the allowed amount of 5.5 ppb or greater. Facility has discontinued use of the drinking fountains at this time. Children are bringing their own water bottles from home.


Please See LIC 809 D for Deficiency

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Director.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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 12/15/2022 10:03 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
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.
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BY POC DUE DATE: Facility will repair drinking fountains and retest to ensure children are safe to use these fountains. Children will also bring own water bottles from home.
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Based on record review, the facility has two drinking fountaints that exceeded the value of 5.5 ppb which poses a potential health and safety risk to children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.

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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: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2