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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000740
Report Date: 03/21/2024
Date Signed: 03/21/2024 10:34:51 AM


Document Has Been Signed on 03/21/2024 10:34 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:GLEN PARK MONTESSORIFACILITY NUMBER:
384000740
ADMINISTRATOR:ROSEMARY RAEFACILITY TYPE:
850
ADDRESS:647 CHENERY STREETTELEPHONE:
(415) 585-7701
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:36CENSUS: 27DATE:
03/21/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana PadillaTIME COMPLETED:
10:45 AM
NARRATIVE
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On March 21, 2024 at approximately 9:30am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, case management visit in regards to lead testing. LPA met with site supervisor, Ana Padilla, and explained the purpose of the visit.

Present during LPA's visit included 27 preschool children with 4 teaching staff (including site supervisor). Montessori program operates in a multi-level building that includes two classrooms. On date of LPA's visit, classroom on the ground floor includes 16 children and classroom on the second level of facility includes 11 children. Both classrooms include a kitchen/food preparation area.

Program provides a food service that includes snack only. Children's families provide children with lunch daily. Children have access to drinking water through filtered water stations located in kitchen/food preparation area. LPA observed filtered water stations are connected to sinks in kitchen/ food preparation areas of each classroom.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA observed sinks and filtered water stations to be labeled and in working condition. Water fixtures used for food preparation and drinking purposes were tested for lead levels March 2023. Water fixtures tested are below the 5.5 ppb threshold.

LPA referred site supervisor to the Department website for lead: Toxicity Prevention and Water Testing Information.

Facility is being cited a Type B citation for not completing lead water testing requirement prior to due date. Appeal rights were provided during visit. Deficiency will be cleared during today's visit as testing was completed.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with site supervisor, Ana Padilla.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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 03/21/2024 10:34 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: GLEN PARK MONTESSORI
FACILITY NUMBER: 384000740

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
HSC
1597.16(a)(1)

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HSC 1597.16(a)(1) A licensed child day care center... that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023...

This requirement is not met as evidenced by:
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Facility tested water fixtures used for food preparation and drinking in March 2023. Water fixtures tested are below the 5.5 ppb threshold.
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Based on interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 in accordance to written directives, which poses a potential health, safety or personal rights risk to persons in care.
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Deficiency cleared during visit.

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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: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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