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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423729
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:27:44 PM

Document Has Been Signed on 10/12/2023 02:27 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:SUPPORTING FUTURE GROWTH CDC, INC.FACILITY NUMBER:
013423729
ADMINISTRATOR:FEARS, LOISFACILITY TYPE:
830
ADDRESS:8411 MACARTHUR BOULEVARDTELEPHONE:
(510) 567-8362
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lois FearsTIME COMPLETED:
10:30 AM
NARRATIVE
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On 10/12/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy met with Supervisor, Lois Fears to conduct a Case Management inspection for the Lead Testing results at the center.

LPAs conducted an inspection of the premises. It was indicated that there were at least two (2) water outlets that exceeded the Action Level established by the State for exposure. Both water outlets are located in the kitchen and were used for food preparation. Supervisor stated outlets were put out of service, fixed and replaced with new ones.

Due to the water outlets used for food preparation, lead exceedance in them posed a potential risk to health and safety of children in care. Deficiency is cited from Written Directives (see 809D). Since the outlets have been corrected and replaced, deficiency was cleared today. Facility will submit the documentation for the post-testing requirements (LIC9275, LIC9276, LIC999).

Exit interview conducted and report was reviewed with the Supervisor, Lois Fears. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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 10/12/2023 02:27 PM - It Cannot Be Edited


Created By: Monica Mathur On 10/12/2023 at 12:35 PM
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: SUPPORTING FUTURE GROWTH CDC, INC.
FACILITY NUMBER: 013423729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2023
Section Cited

101700.3(b)(2)

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101700.3(b)(2) Licensees 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 is not met as evidenced by:
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Supervisor stated outlets were put out of service, fixed and replaced with new ones. This citation was cleared today. Letter of clearance was provided.
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Center's two (2) water outlets that exceeded the Action Level established by the State for exposure, located in the kitchen and were used for food preparation. This posed a potential risk to health/safety of 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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