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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500240
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:40:03 PM


Document Has Been Signed on 10/26/2023 01:40 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:GLENRIDGE COOPERATIVE NURSERY SCHOOLFACILITY NUMBER:
380500240
ADMINISTRATOR:CAMPBELL, MARIELLENFACILITY TYPE:
850
ADDRESS:GLEN PARK CANYON (CHENERY-ELK)TELEPHONE:
(415) 586-2771
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:25CENSUS: 15DATE:
10/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Mame CampbellTIME COMPLETED:
02:00 PM
NARRATIVE
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On October 26, 2023, Licensing Program Analyst (LPA) Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with director, Mame Campbell. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 15 children, with 2 staff members and 3 parent volunteers.

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 October 8, 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. The affected fixture is F(9.6) and per director, it is a utility sink that was replaced after the first lead water testing due to the ALE. The sink is located in the bathroom used mainly for janitors for cleaning. LPA observed that the sink has a sign indicating that the sink is used only for mopping, cleaning and adult hand washing.

The facility was initially directed by LPA that the sink does not need retesting due to the location and utilization of the sink and putting signs would suffice as a plan of correction (POC). However, due to updated guidance on the written directives in the PIN 21-21.1-CCP, the facility will be cited for the action level exceedance of the fixture.

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

* See next page for deficiencies cited today

This report was reviewed and signed by Director, Mame Campbell .

This notice of Site visit was 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: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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 10/26/2023 01:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: GLENRIDGE COOPERATIVE NURSERY SCHOOL
FACILITY NUMBER: 380500240

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2023
Section Cited

101700.3

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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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The facility replaced the affected fixture and will schedule a retest with the certified water samplers. Director will submit a date for retest and update the LPA for the retest results, once available.
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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. This pose a potential health, safety, or personal rights risk to persons in care.
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The retest results will be forwarded to the department by set due date.

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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 OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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