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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700591
Report Date: 02/06/2024
Date Signed: 02/06/2024 01:50:22 PM

Document Has Been Signed on 02/06/2024 01:50 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:SAFARI KID - HAYWARDFACILITY NUMBER:
015700591
ADMINISTRATOR:RATHI, SEEMAFACILITY TYPE:
850
ADDRESS:26236 ADRIAN AVENUETELEPHONE:
(510) 364-9651
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 101TOTAL ENROLLED CHILDREN: 73CENSUS: 59DATE:
02/06/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Seema RathiTIME COMPLETED:
01:50 PM
NARRATIVE
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On 2/6/2024 at 12:45pm, Licensing Program Analyst (LPA) Morgan Pringle conducted a case management inspection due to the center's lead testing results. The facility is on the New Bridges Presbyterian Church grounds and the preschool operates in Building 1 and Building 7. LPA met with Director Seema Rathi. There were thirteen (13) toddlers, forty-six (46) preschool age children, ten (10) additional staff and five (5) child therapists present during the inspection.

The department was notified on 11/17/2022 that one (1) water faucet located in the Peach Room had elevated lead levels that have exceeded 5.5 ppb. This exceeded the Action Level (ALE) established by the state for lead exposure.

The classroom has not been used by children since 2019 and the faucet is not accessible to the children in care. LPA Pringle informed Director that the faucet will need to be removed or remediated.

See LIC809D for Type B deficiency cited during today's inspection.

Exit interview conducted with Director Seema Rathi. A notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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 02/06/2024 01:50 PM - It Cannot Be Edited


Created By: Morgan Pringle On 02/06/2024 at 12:57 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SAFARI KID - HAYWARD
FACILITY NUMBER: 015700591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2024
Section Cited

101700.3(b)(1)

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101700.3(b)(1)-Lead Testing Written Directive- A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE)
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Director will inform LPA Pringle if the faucet will be removed or remediated. Once the decision has been made, Director will submit proof of a retest or proof showing the faucet has been removed and made inaccessable to the children in care.
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This requirement is not met as evidenced by: Based on record review, the facility had 1 outlet in the Peach Room that had an ALE of 5.5ppb or greater which posed 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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2024


LIC809 (FAS) - (06/04)
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