<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420528
Report Date: 05/08/2024
Date Signed: 05/08/2024 04:02:17 PM


Document Has Been Signed on 05/08/2024 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:DR. HERBERT GUICE CHRISTIAN ACADEMYFACILITY NUMBER:
013420528
ADMINISTRATOR:ANGELA DARBYFACILITY TYPE:
850
ADDRESS:6925 INTERNATIONAL BLVDTELEPHONE:
(510) 729-0330
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY:57CENSUS: 9DATE:
05/08/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Karen FreemanTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA's) B.Govindasamy and D. Campos met with Director Karen Freeman to conduct an unannounced Case Management inspection regarding a lead exceedance from a faucet in the center. The kitchen sink faucet identified as faucet (D) exceeded the acceptable amount of lead allowed in a child care center. During the unannounced inspection LPA's toured the facility for a health and safety check. Present during today's inspection were 9 children and 3 staff. Facility had a lead test completed on 4/16/2022 and was not previously cited for the reported exceedance. LPA returned today to address the deficiency for the previously reported exceedance in the kitchen identified as faucet (D).

LPA's observed the faucet identified as faucet (D) continues in inoperable condition during the inspection. Director stated she does not recall faucet (D) being used for drinking or cooking at any time and has been permanently shut off. Director stated facility decided to permanently discontinue use of the sink but did not physically remove sink from facility. Director understands that in order to remediate the lead exceedance the sink (Facuet D) must be either repaired and retested or permanently removed from facility. Faucet (D) will continue to remain inoperable and not be used.

See LIC809D for deficiency cited today.

Exit interview and report reviewed with Teacher La Neco Brandy.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
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 05/08/2024 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: DR. HERBERT GUICE CHRISTIAN ACADEMY
FACILITY NUMBER: 013420528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
1
2
3
4
5
6
7
One outlet in kitchen that is not currently in use (faucet D) and made inaccessible to children. The facility is working on removing the outlet, and will submit plan of action with approximate time frames for removal, by 05/22/24.
8
9
10
11
12
13
14
This requirement has not been met as evidenced by the lead testing results received, indicating that one outlet in the facility had results in exceedance of the 5 ppb Action Level. This poses a potential risk to the children in care.
8
9
10
11
12
13
14
Director understands if more time is required to remediate exceedance this will be requested directly to LPA supervisor S. Johnson.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2