384001019-3-26-2024-05-CC-CMOK-D3QUR9-20240326154823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001019
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:49:21 PM

Document Has Been Signed on 03/26/2024 03:49 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:	KAI MING HEAD START-RICHMOND		FACILITY NUMBER:	384001019
ADMINISTRATOR:	ELLEN PETERSON-ALLEN		FACILITY TYPE:	850
ADDRESS:	426 33RD AVENUE, 2ND FLOOR		TELEPHONE:	(415) 386-3096
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	30	CENSUS: 18	DATE:	03/26/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Kelly Li		TIME COMPLETED:	01:10 PM

NARRATIVE

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Licensing Program Analysts (LPA) Mok conducted an unannounced case management for the Lead water Test Exceedance today. LPA met with Site Director, Kelly Li and an Administrative, Sasha Camel. The purpose of inspection was explained to them. The case management inspection was for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA was given a tour of the facility. There were 18 children and 8 staff present. .

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 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 December 7, 2023 . Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The affected fixtures are as follows.

Child Day Care Areas:

Fixture	Result (ppb)
A C	6.2 6.9

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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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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: KAI MING HEAD START-RICHMOND	FACILITY NUMBER: 384001019
	VISIT DATE: 03/26/2024

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The fixture A (6.9 ppb) is in the child day care area for hand washing only. Also, the fixture C is in the Staff bathroom for hand washing as well. The Director proactively using a 5-gallon bottle dispenser to provide the water for the children teeth brushing. The source of the water is using the distilled water from outside vendor. The Director made the affected fixtures for hand washing only until replaced the new ones and retested with results below 5.5ppb. The schedule summary is as follows.

· 03/27/24: installation of the new faucets
· 04/5/2024: retest

Per the updated guidance on written directives in PIN 21-21.1-CCP, facility will be cited for the actionable level exceedance of the fixtures.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were discussed and given to the Director. The Notice of Site Visit was given to the director and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Kelly Li.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/26/2024 03:49 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: KAI MING HEAD START-RICHMOND	FACILITY NUMBER: 384001019
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/26/2024 Section Cited HSC 101700.3(b)(1)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	The Director stated that the facility would replace the affected fixtures and will schedule a retest with certified water samplers. The director will update the LPA for the retest results once available.
	8 9 10 11 12 13 14	Based on results received from the certified water samplers, the facility did not ensure the lead in their water source below 5.5 ppb, which poses/posed a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	The retest results will be forwarded to the department by the set due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

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