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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421978
Report Date: 09/21/2022
Date Signed: 09/21/2022 12:21:39 PM


Document Has Been Signed on 09/21/2022 12:21 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:NATURE'S GIFT PRESCHOOL, LLCFACILITY NUMBER:
013421978
ADMINISTRATOR:MAR, YIN YINFACILITY TYPE:
850
ADDRESS:38255 BLACOW RDTELEPHONE:
(510) 608-6080
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:49CENSUS: 29DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Yin Yin MarTIME COMPLETED:
12:30 PM
NARRATIVE
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On September 21, 2022 at approximately 10:06am Licensing Program Analyst (LPA) R. Haderer arrived for a scheduled meeting with site director Yin Yin Mar to discuss the results of the recent lead test. There were 29 children in care and 7 fingerprint and associated staff present. The center is in ratio today.

A lead test was completed for water locations intended for human consumption for faucets (Location A and B) on June 18, 2022 and analyzed on June 22, 2022. Location A is the sink in Room 4; Location B is the outside drinking fountain. The test results showed the lead levels on Location A were "ND - Analyte Not Detected" (no lead present). The results for Location B found 7.5 ppb level. A result with values of 5.5 ppb or greater is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction.

The fountain was taken out of use since March 2020 (due to Covid). LPA completed 2 site inspections over the past two years and LPA witnessed the outside water fountain had been closed and noted this in the facility reviews on August 26, 2021 and also June 30, 2022. LPA stated "There is an outside drinking fountain that is not in use at this time (due to Covid concerns)."

The center director believes the water fountain may not have been properly flushed prior to the sampling and therefore caused a false reading. A Plan of Correction will be discussed with the Church (property owner) and followed up by the agreed on a remedy of:
1. The faucet on the fountain will be replaced and a new sample and test will be conducted; or
2. The fountain will be converted into a handwashing basin and not used for human consumption; or
3. The Fountain will be permanently closed.

A Type B deficiency was issued today, see LIC809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site director Yin Yin Mar.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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 09/21/2022 12:21 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: NATURE'S GIFT PRESCHOOL, LLC
FACILITY NUMBER: 013421978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2022
Section Cited

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101238 Buildings and Grounds
(a) 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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1. The faucet on the fountain will be replaced and a new sample and test will be conducted; or
2. The fountain will be converted into a handwashing basin and not used for human consumption; or
3. The Fountain will be permanently closed.

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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: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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