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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001835
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:40:19 PM


Document Has Been Signed on 09/15/2022 02:40 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SOUTHEAST FAMILIES UNITED/CHILDREN'S CENTERFACILITY NUMBER:
384001835
ADMINISTRATOR:EUGENIA JAMESFACILITY TYPE:
830
ADDRESS:1337 EVANS AVENUETELEPHONE:
(415) 920-7000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:20CENSUS: 12DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Andres TobarTIME COMPLETED:
03:00 PM
NARRATIVE
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On September 15, 2022 at approximately 1:30 PM, 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. LPA met with the Educational/ Family Engagement Specialist, Andres Tobar. The purpose of the inspection was explained.

Facility is a combination center that includes a preschool and infant license. Present in facility #384001835 are 12 children present with 4 staff members in total.

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 6/23/2022. 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 putting signs indicating that the water fountain is not for drinking and is currently out of order. The facility took action to contact the facility's management to repair and replace the fixture. Per asst. director, the affected fixtures J (9.8) is located in the staff kitchen and was not primarily used, until recently. The repaired fixtures are currently being flushed 4 times a day and being left stagnant for 8+ hours per day, as directed by the certified water samplers. The facility will be scheduling a retest with the certified water samplers three weeks after the flush has been done. The fixture still has 1 week left of flushing.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), and a copy of an email of the checklist for running the water after the repair, on 8/25/22.


* See next page for deficiency cited today

This report was printed and given to Andres Tobar

This report and notice of Site visit and appeal rights were 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: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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 09/15/2022 02:40 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SOUTHEAST FAMILIES UNITED/CHILDREN'S CENTER
FACILITY NUMBER: 384001835

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2022
Section Cited

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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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Based on results received from the certified water samplers, the facility exceeded 5.5ppb of lead in their water source. Once recieved, the facility took immediate and proper actions to remediate the fixtures.
This poses a potential health, safety, or personal rights risk to persons in care.
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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: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
LIC809 (FAS) - (06/04)
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