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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405624
Report Date: 09/07/2022
Date Signed: 09/07/2022 12:17:13 PM


Document Has Been Signed on 09/07/2022 12:17 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:HIGHLANDS PRE-K PROGRAMFACILITY NUMBER:
073405624
ADMINISTRATOR:MULLEN, DANETTEFACILITY TYPE:
850
ADDRESS:1326 PENNSYLVANIA AVE.TELEPHONE:
(925) 672-6144
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:30CENSUS: 0DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Ko ParkTIME COMPLETED:
12:15 PM
NARRATIVE
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On 9/7/22 at 11:15 AM Licensing Program Analyst (LPA) Michelle Sutton and Monica Mathur met with Director Ko Park to conduct a Case Management inspection for the Lead Testing results at Highlands Pre-K Program.

LPA conducted an inspection and toured the premises. It was indicated that there was one outlet exceeded the Action Level established exposure. LPA received a Plan of Correction and facility has submitted the documentation for the post-testing requirements.

The following deficiency is (See LIC 809-D.) cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Ko Park.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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 09/07/2022 12:17 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: HIGHLANDS PRE-K PROGRAM
FACILITY NUMBER: 073405624

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2022
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. This requirement is not met as evidenced by
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Based on Lead Testing Samples the facility has one water faucet for lead exposure. This is an potential risk to Health and Safety or Personal Rights risk to persons in care.
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LPA will be clearing the citation today as of 9/7/22

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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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