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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709415
Report Date: 07/03/2025
Date Signed: 07/03/2025 09:54:46 AM

Document Has Been Signed on 07/03/2025 09:54 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SOJOURNER TRUTH CHILD DEVELOPMENT CENTERFACILITY NUMBER:
430709415
ADMINISTRATOR/
DIRECTOR:		NGUYEN, MARYFACILITY TYPE:
830
ADDRESS:3990 VENTURA COURTTELEPHONE:
(650) 493-5990
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 12DATE:
07/03/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mary NguyenTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On 07/03/2025 at 9:00am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu conducted an unannounced case management inspection for the purpose of following up on a reported Lead Testing/Exceedance. LPA met with Director Mary Nguyen and Palo Alto Community Child Care (PACCC) Facilities Coordinator Dave Carlson. Also present during the inspection were seven (7) fingerprint-cleared staff and 12 infants in care. The facility is within ratio and in compliance with capacity regulations today. LPA toured the area of the facility where the water was tested for lead.

LPA discussed with Director that Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Health and Safety (HSC) Code section 1597.16 authorizes the Department to implement and administer procedures for lead testing at CCCs through written instructions until it adopts regulations under the Administrative Procedure Act.

Page 1 of 2. See LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SOJOURNER TRUTH CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430709415
VISIT DATE: 07/03/2025
NARRATIVE
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Sample ID 430709415 J* – Sink Faucet_MP Rm (collected on 05/03/2025) had a Lead Action Level of Exceedance Response of 5.5 ppb or greater.

Sample ID 430709415 A* – Kitchen (collected on 05/22/2025) had a Lead Action Level of Exceedance Response of 5.5 ppb or greater.

*Sample IDs 430709415 J and 430709415 A are the same fixture. This fixture is located in the Multipurpose Room of the same address as the facility. However, it is not located in the areas licensed for child care. Per Facilities Coordinator, this fixture is 1 of 2 fixtures used for food prep (mainly fruits and vegetables). The food prepared at this location is distributed to all licensed PACCC childcare facilities. Each sample was conducted by a different sampler/vendor on different dates. Sample ID 430709415 J is the original test date that resulted with a lead exceedance. Following the lead exceedance result, Facilities Coordinator contacted the second vendor to conduct a retest to verify the results are accurate, which is Sample ID 430709415 A. Though the ppb value from both samples varied, both resulted in a Lead Action Level of Exceedance Response of 5.5 ppb or greater.

As a result of the lead exceedance, a Type B deficiency is cited during today's inspection. See LIC 809D for details.

The facility has already taken action to address the lead exceedance. Per Facilities Coordinator, after confirmation of lead exceedance, the use of both faucets in the Multipurpose Room was discontinued. A plumbing company was contracted to replace all supply lines and both faucets used for food prep. (Please note that only 1 of 2 tested faucets resulted in a lead exceedance.) The replacement was completed on 06/25/2025. Retest of faucets after replacement is pending but will be likely completed by end of July. Until the new testing results are received, all lunch foods for PACCC programs are being provided by a third party vendor.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Director Mary Nguyen.

Page 2 of 2. End of Report.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2025 09:54 AM - It Cannot Be Edited


Created By: Jialing Zhu On 07/03/2025 at 09:31 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SOJOURNER TRUTH CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 430709415

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2025
Section Cited
CCR
101700.3(c)

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101700.3(c) If testing indicates an Action Level Exceedance (5.5 ppb or greater) at any water outlet, the water from that outlet is deemed not safe to drink and an immediate response pursuant to section 101704 shall be required.
This requirement is not met as evidenced by:
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The faucet with lead exceedance must not be used for drinking or food prep unless it is replaced or retested, and a new water sampling is conducted with no lead exceedance indicated. LPA has received confirmation the faucet is not currently used for drinking or food prep.
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Based on record review, the licensee did not comply with the section cited above as one or more water outlets tested for lead had an exceedance of 5.5ppb or greater, which is a potential health and safety risk to persons in care.
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Faucet(s) have been replaced. When retesting is completed, Director or Facilities Coordinator will email results to LPA via email at jialing.zhu@dss.ca.gov.

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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.
Chandra Charles
NAME OF LICENSING PROGRAM MANAGER:
Jialing Zhu
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2025


LIC809 (FAS) - (06/04)
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