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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422497
Report Date: 09/21/2022
Date Signed: 09/21/2022 04:02:48 PM


Document Has Been Signed on 09/21/2022 04:02 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:LITTLE LAMB BILINGUAL PRESCHOOLFACILITY NUMBER:
013422497
ADMINISTRATOR:LV, MUCHANFACILITY TYPE:
850
ADDRESS:924 ADAMS STREETTELEPHONE:
(510) 610-2421
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:24CENSUS: 18DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Muchun LvTIME COMPLETED:
04:17 PM
NARRATIVE
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On Wednesday, September 21, 2022 at 2:26 PM, Licensing Program Analyst (LPA) Caroline Colson met with Muchun Lv, Center Director, for a case management inspection for Lead Testing Results. There are 18 preschool children and 3 staff members including center director. A tour of the facility was conducted. Test Results were obtained. It was concluded that there is one faucet located on the deck that has elevated lead levels established by an certified independent water sampler.

Please See LIC 809 D for Deficiency

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Muchun Lv, Center Director.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
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)
Page: 1 of 2


Document Has Been Signed on 09/21/2022 04:02 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: LITTLE LAMB BILINGUAL PRESCHOOL
FACILITY NUMBER: 013422497

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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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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Based on record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons 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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
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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