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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423099
Report Date: 07/26/2023
Date Signed: 07/26/2023 10:09:35 AM

Document Has Been Signed on 07/26/2023 10:09 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:ROSEMARIE'S MOTIVATIONAL PRESCHOOLFACILITY NUMBER:
013423099
ADMINISTRATOR:HOLMES, JOYCEFACILITY TYPE:
850
ADDRESS:1141 BANCROFT WAYTELEPHONE:
(510) 990-6439
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 8DATE:
07/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:56 PM
MET WITH:Ravina GattisonTIME COMPLETED:
10:12 PM
NARRATIVE
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On July 26, 2023 at 8:56 AM Licensing Program Analyst (LPA), Indira loza conducted an unannounced case management inspection to follow up on a lead exceedance at the facility. LPA met with Licensee Rosalind Roberts, 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 the outlet labeled "D" outside in the play area. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink (See 809D). During today's visit, LPA verified the water fountain was made inoperable. The licensee was advised to place a sign on the faucet that indicates it is not to be used.

Report was reviewed with Director Joyce Holmes

Appeal Rights and Notice of Site Visit were provided.

Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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 07/26/2023 10:09 AM - It Cannot Be Edited


Created By: Indira Loza On 07/26/2023 at 09:18 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: ROSEMARIE'S MOTIVATIONAL PRESCHOOL
FACILITY NUMBER: 013423099

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited

101700.3(c)

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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. This requirement was not met as evidenced by:
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The facility made the water fountain temporarily inoperable.

By August 25, 2023,the Licensee shall submit proof of arrangements to either replace the fountain or to make it completely inoperable.
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Based on record review the Licensee did not comply with the above Written Diirective as the faucet "D" had a lead exceedance which poses a potential Health and Safety risk to children 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023


LIC809 (FAS) - (06/04)
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