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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500512
Report Date: 11/01/2023
Date Signed: 11/01/2023 11:57:43 AM


Document Has Been Signed on 11/01/2023 11:57 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:PHOEBE A. HEARST PRESCHOOL LEARNING CENTERFACILITY NUMBER:
380500512
ADMINISTRATOR:BYRNE, IRENEFACILITY TYPE:
850
ADDRESS:1315 ELLIS STREETTELEPHONE:
(415) 931-1018
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY:125CENSUS: 61DATE:
11/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Irene ByrneTIME COMPLETED:
12:15 PM
NARRATIVE
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On November 1, 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, Irene Byrne. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 61 children, with 11 teacher.

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 July 9, 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 fixtures are C(12), D(14), and G(54) parts per billion (ppb). Per director, fixtures C is a water fountain located in the play yard. Fixtures D and G are garden hoses used for watering plants or any outdoor water play. According to the director, fixture C was retested on September 23, 2022 and was relabled as fixture 'A', with the results showing less than 1 ppb of lead in the water. LPA observed that the remediated fixture has a filter installed and the other fixtures have labels on them indicating not to use for drinking or food preparation.

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

* See next page for deficiencies cited today

This report was reviewed and signed by Director, Irene Byrne.

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: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/01/2023 11:57 AM - 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: PHOEBE A. HEARST PRESCHOOL LEARNING CENTER
FACILITY NUMBER: 380500512

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2023
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 remediated and retested the fixture 'C'(relabeled as 'A'), which is used for drinking on September 23, 2022. The other fixtures 'D' and 'G' will also me remediated and tested. The facility will update LPA for scheduled retest date and results will be forwarded to LPA for verification.
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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 facility will notify LPA of the retest results 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: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
LIC809 (FAS) - (06/04)
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