<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002728
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:14:14 PM


Document Has Been Signed on 09/27/2023 03:14 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:SOJOURNER TRUTH CENTERFACILITY NUMBER:
384002728
ADMINISTRATOR:ALCANTARA, TELMAFACILITY TYPE:
830
ADDRESS:1 CASHMERE STREETTELEPHONE:
(415) 401-1379
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:45CENSUS: 24DATE:
09/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Telma AlcantaraTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/27/23 at approximately 2:15 PM, Licensing Program Analysts (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 director, Telma Alcantara.
Present in facility were 24 children, with 7 staff members.

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 3/1/2023. 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/kitchen fixture is not for drinking and or food preparation. LPA observed that the faucets are sinks, located in two day care rooms and one is located in the staff lounge. Per director, the affected fixtures A (8.3), C (8.5) and D (23) has been retested back in June to get an approval from the HSA (owner of the property). Per director, the last update they had was the replacement of the faucets being approved last month. All of affected fixtures will be replaced and retested again, after flushing. Per staff, the second retest reveals that only one of the faucets came up above the 5ppb of lead threshold. LPA checked the database for the second retest results that was done in June and it was not uploaded. Per Erika, the water samplers put the wrong facility number (384002726) instead of (384002728). The facility is using other sources of water such as water services for food preparation and water ingestion. LPA also observed that there are multiple water dispensers located throughout the facility, which the children use for drinking and food preparation.

LPA requested for the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), forms will be emailed to LPA.

* See next page for deficiencies cited today

This report was reviewed and signed by Director, Telma Alcantara.

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: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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 09/27/2023 03:14 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: SOJOURNER TRUTH CENTER
FACILITY NUMBER: 384002728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited

101700.3

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 facility willl replace and retest the affected fixtures. Then the facility will flush for three weeks and schedule another retest date with the certified water samplers. The new results will be forwarded to the LPA and reviewed.
8
9
10
11
12
13
14
Based on results received from the certified water samplers, the facility exceeded 5.4 ppb of lead in their water source. Once received, 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.
8
9
10
11
12
13
14
The facility will also update the department for the updated status of the repairs and retest 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: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2