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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405603
Report Date: 04/27/2023
Date Signed: 04/27/2023 11:55:40 AM

Document Has Been Signed on 04/27/2023 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:GEORGE MILLER CENTER - RICHMONDFACILITY NUMBER:
073405603
ADMINISTRATOR:CHRISTINE ROTTGERFACILITY TYPE:
840
ADDRESS:2801 ROBERT MILLER DRIVETELEPHONE:
(510) 374-3981
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
04/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Katina JonesTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Diana Campos met with Program Coordinator Katina Jones to conduct an unannounced case management inspection regarding a lead exceedance from a faucet in the center. The faucet in the after school program hallway identified as faucet A exceeded the acceptable amount of lead allowed in a child care center. During the unannounced inspection LPA toured the facility for a health and safety check. No children were present during today's inspection.

LPA observed the faucet identified as faucet A has been removed entirely during the inspection. Program Coordinator stated that faucet has been removed and will not be replaced. The facility submitted copies of the lead testing report, correction plan and pictures to the licensing office.

See 809-D for deficiency.

Exit interview and report reviewed with Program Coordinator Katina Jones.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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 04/27/2023 11:55 AM - It Cannot Be Edited


Created By: Diana Campos On 04/27/2023 at 11:23 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: GEORGE MILLER CENTER - RICHMOND
FACILITY NUMBER: 073405603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directive
A result with values of 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement has not been met as evidenced by:
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Faucet identified as faucet A has been entirely removed and will not be replaced. The citation is cleared during today's visit.
The facility has previously submitted copies of the report, correction and pictures to the licensing office.
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Based on record review a faucet at the facility (identified as faucet A) used by children had a lead exceedance, which poses a potential risk to the health and 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:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
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