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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206130
Report Date: 05/24/2023
Date Signed: 05/24/2023 11:55:24 AM

Document Has Been Signed on 05/24/2023 11:55 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - HIGHLANDFACILITY NUMBER:
010206130
ADMINISTRATOR:TURNER, ALFREDAFACILITY TYPE:
850
ADDRESS:1322 - 86TH AVENUETELEPHONE:
(510) 879-0815
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 96TOTAL ENROLLED CHILDREN: 47CENSUS: 28DATE:
05/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kianga LeeTIME COMPLETED:
12:00 PM
NARRATIVE
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On 05/24/2023 at 8:45AM Licensing Program Analyst (LPA) A. Curry conducted an unannounced case management inspection to follow up on a lead exceedance at the facility. LPA met with site principal, Kianga Lee, to explain the purpose of today's inspection. The licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5ppb or greater for outlet A. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink (See 809D). The site principal indicated the children have not used the faucet since before COVID. Once facility received the lead testing results, the facility immediately made the fountain inoperable by cutting off the water line, placing a bag over it, and by placing an Out of Order sign next to the sink.

Exit interview conducted, appeal rights were given, and report was reviewed with Site Principal, Kianga Lee.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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 05/24/2023 11:55 AM - It Cannot Be Edited


Created By: Ashley Curry On 05/24/2023 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OUSD - HIGHLAND
FACILITY NUMBER: 010206130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2023
Section Cited
CCR
101700.3

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Licensee 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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By 06/23/2023 the facility will submit a written plan that indicates when outlet A will be repaired or permanently removed.
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Based on interview and record review the licensee did not comply with the section cited above as outlet C exceeded the acceptable amount of lead allowed in a child care center, which poses 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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
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