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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422032
Report Date: 04/17/2024
Date Signed: 04/17/2024 04:26:57 PM


Document Has Been Signed on 04/17/2024 04:26 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:AB'S PRESCHOOL AND DAYCAREFACILITY NUMBER:
013422032
ADMINISTRATOR:AYALEW, MERATFACILITY TYPE:
830
ADDRESS:301 DOWLING BLVDTELEPHONE:
(510) 564-4276
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:12CENSUS: 3DATE:
04/17/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rgbe HaileTIME COMPLETED:
04:45 PM
NARRATIVE
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On 4/17/2024 at 9:15AM Licensing Program Analysts (LPAs) Jaleesa Jackson and Manel Estoesta conducted a Case Management - Lead Testing/Exceedance Inspection. LPA met with Facility Representative Rgbe Haile. LPA was provided a tour of the facility inside and out. Also present during today's inspection were 3 infants in care.

Director Merat Ayalew arrived at the facility at 10:58AM.

LPA discussed to the Director the PIN 21-21.1-CCP - WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS (CCC) PURSUANT TO AB 2370 CHAPTER 676, STATUTES OF 2018 https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21_1-CCP.pdf
Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer the health and safety requirements related to lead exposure and testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

The department was notified that the facility had elevated lead levels that had exceeded 5.5 ppb. This exceeded the Action Level Exceedance (ALE) established by the state for lead exposure. Sample A from sink faucet in the kitchen had a Lead Action Level of Exceedance Response test date of 03/02/2024 of 5.5 ppb or greater. The Director stated they have not utilized the sink and have chosen to have the fixture replaced. Facility will be retesting and if exceedance is still found, removal or replacement will occur.

A notice of site visit was given and must remain posted for 30 days.

Appeal rights provided. Exit interview was conducted with Director Merat Ayalew.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa JacksonTELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
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 04/17/2024 04:26 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: AB'S PRESCHOOL AND DAYCARE
FACILITY NUMBER: 013422032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
Section Cited

101700.3(b)(2)

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 Lead Testing Written Directive- Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.
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Facility will make sink inaccessible to children in care. The Director will replace the fixture and have it retested. Results must be sent to LPA by POC date by email.
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This requirement is not met as evidenced by:
Based on record review, facility has outlets of water test 5.5 ppb or greater, which is a potential health and safety risk to persons 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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa JacksonTELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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