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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210111538
Report Date: 02/07/2023
Date Signed: 02/07/2023 04:01:56 PM


Document Has Been Signed on 02/07/2023 04:01 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:C.A.M (CFS) HAMILTON (SA)FACILITY NUMBER:
210111538
ADMINISTRATOR:LOMBARDI KELSEYFACILITY TYPE:
840
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-4385
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:47CENSUS: 19DATE:
02/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Alida LeonTIME COMPLETED:
04:15 PM
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On 2/7/23 at 10:30AM, Licensing Program Analyst (LPA) Nathan Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water in conjunction with annual inspection and opening complaint investigation with preschool License. LPA met with the Site Manager, Alida Leon. The purpose of the inspection was explained.

There were 19 children present with 4 teachers.

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 11/5/2022. 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 barricaded and or made the affected fixture out of order. LPA Garcia met with Facilities manager and showed that the affected fixture C (10) is a water fountain outside that was turned off and and was made inaccessible. Per facilities manager, the Water fountain will be removed on 2/8/23 and will provide pictures for confirmation.

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. LPA obtained copy of the lead water testing results as well.

No deficiencies will be cited for today due to the fixture being inaccessible at the time of visit and another water source available in the classroom and the proactive remediation of the affected fixture. The children also has been using water bottles refilled through Brita pitchers from unaffected water source inside the classroom.

This report and notice of Site visit is provided to the licensee and must remain posted for 30 days.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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