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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002200
Report Date: 03/24/2023
Date Signed: 03/24/2023 03:33:45 PM


Document Has Been Signed on 03/24/2023 03:33 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:FACESSF - BAYVIEW SCHOOL AGEFACILITY NUMBER:
384002200
ADMINISTRATOR:KING, ROBYNFACILITY TYPE:
840
ADDRESS:100 WHITNEY YOUNG CIRCLETELEPHONE:
(415) 821-7550
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:90CENSUS: 6DATE:
03/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Robyn King and Shanee FisherTIME COMPLETED:
03:55 PM
NARRATIVE
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On March 24, 2023 at 1:30 PM, Licensing Program Analyst (LPA) April Cowan conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the director, Robyn King and operations coordinator, Shanee Fisher for this inspection. The purpose of the inspection was explained.

Present director, 7 staff, and, 6 children in care.

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 1/21/23. 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 on two faucets indicating that the water fountain/kitchen fixture is not for drinking and is currently out of order. The facility took action to repair and replace the 3 fixture. Per director, the certified plumber visited on 3/16/23 to replace the 3 kitchen faucets that need replacing.

Per director, plumbers will be replacing the remaining faucets the week of March 27, 2023. The facility has filtered water in class for children to drink.Once the faucet is installed, the facility will be flushing the fixture as instructed 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 facility is planning to utilize the affected fixtures once they are repaired.

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

* See next page for deficiency cited today
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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 03/24/2023 03:33 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: FACESSF - BAYVIEW SCHOOL AGE
FACILITY NUMBER: 384002200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2023
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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The facility has included some signs and place signs on remaining faucets. Facility will replace the fixtures affected and will be flushing the water fixture until they are retested with a certified water sampler.
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Based on results received from the certified water samplers, the facility exceeded 5.5 ppb of lead in their water source. Once received, the facility began taking 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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