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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102741
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:38:52 PM

Document Has Been Signed on 10/11/2023 03:38 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ALL SAINTS PRESCHOOL & CHILDRENS CENTERFACILITY NUMBER:
210102741
ADMINISTRATOR:BOYDEN, KRISTIEFACILITY TYPE:
850
ADDRESS:2 SAN MARIN DRIVETELEPHONE:
(415) 893-4202
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 13DATE:
10/11/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:52 PM
MET WITH:Susan KovarikTIME COMPLETED:
03:45 PM
NARRATIVE
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On 10/7/23, Licensing Program Analyst (LPA) Garcia and Licensing Program Manager (LPM) Oquendo conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with assistant director, Susan Kovarik. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 13 children, present with 2 staff members.

LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the site director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

The facility received the ALE report from the Vendor on February 1, 2023. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The facility was proactive in getting facility faucets tested and putting signs indicating that the water fountain/kitchen fixture is not for drinking and or currently out of order. Per director, the affected fixture A (27) is a water fountain located in one of the classrooms. The facility is using other sources of water, sinks that passed the tests, for food preparation and water ingestion or refill. According to the director, the water fountain has not been used since the pandemic in 2020. LPA and LPM observed, tested and confirmed that the water fountain is inoperable. The facility updated the agency about the POC of this fixture on 3/14/23 with a photo.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), in an email to the LPA.

* See next page for deficiencies cited today and will also be cleared on the same day.

This report was reviewed and signed by assistant Director, Susan Kovarik .

This notice of Site visit was provided to the licensee and must remain posted for 30 days.

Daniel J Oquendo
Nathan Garcia
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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 10/11/2023 03:38 PM - It Cannot Be Edited


Created By: Nathan Garcia On 10/11/2023 at 03:06 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALL SAINTS PRESCHOOL & CHILDRENS CENTER
FACILITY NUMBER: 210102741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited

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101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by:
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Based on results received from the certified water samplers, the facility exceeded 5.4 ppb of lead in their water source. Once received, the facility took immediate and proper actions to remediate the fixtures.
This poses a potential health, safety, or personal rights risk to persons in care.
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Deficiency will be issued and cleared during the same visit on 10/11/23.

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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023


LIC809 (FAS) - (06/04)
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