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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002781
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:12:03 PM


Document Has Been Signed on 08/30/2023 04:12 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:ANGELA'S CHILDREN CENTERFACILITY NUMBER:
384002781
ADMINISTRATOR:HUANG, HUIRUFACILITY TYPE:
830
ADDRESS:775 - 7TH AVENUETELEPHONE:
(415) 386-0184
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:36CENSUS: 23DATE:
08/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Huang, HuiriTIME COMPLETED:
04:20 PM
NARRATIVE
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On 8/30/23 at approximately 2:45PM, Licensing Program Analysts (LPAs) Nathan Garcia and Jonathan Tse conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPAs met with the Owner, Angela Coo.
Present in facility are 23 children, present with 14 staff members before nap time.

LPAs 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 4/22/2023. 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 currently out of order. Per Licensee, the affected fixture D (23) is not being used for any kind water ingestion and food preparation. The facility using other sources of water that passed the lead water testing for food preparation and water ingestion.

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. LPAs obtained a copy of the lead water testing results as well.

***See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
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 3


Document Has Been Signed on 08/30/2023 04:12 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: ANGELA'S CHILDREN CENTER
FACILITY NUMBER: 384002781

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2023
Section Cited
CCR
101430(a)(3)(C)

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101430 Infant Care Activities
(a) Notwithstanding Section 101230, the following shall apply:
(3)(C) An infant shall not be swaddled while in care.
This requirement was not met as evidenced by:
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The facility removed infant's swaddle during the visit.
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Based on observations of the LPAs, the child under 12 months old was swaddled in the crib while napping.

This poses an immediate health, safety, or personal rights risk to persons in care.
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The director agrees to train staff on Safe sleep Regulations, send meeting agenda to LPA, and have each staff present sign by the above stated date as a follow up.
Type B
10/02/2023
Section Cited
101700.3

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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 signs for the affected fixture. The facility is waiting for affected fixture to be replaced and will be flushing the water fixture until they are retested with a certified water sampler by 10/2/23.
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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.
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Per Owner, the facility will have the fixture replaced the weekend of September 2nd and schedule a retest with new results by set due date. The fixtures will be inaccessible until the retest shows they are under the 5.4ppb of lead threshold.
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: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3


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: ANGELA'S CHILDREN CENTER
FACILITY NUMBER: 384002781
VISIT DATE: 08/30/2023
NARRATIVE
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***Page 2 continued***

On the same visit, at 3:00pm, LPAs observed during head count that one infant child whose date of birth is October 24, 2022 was in the crib swaddled while sleeping. LPAs immediately told staff that swaddling an infant is not allowed and they immediately removed the blankets from the child.


* See next page for deficiencies cited today

This report was reviewed and signed by Owner, Angela Coo.

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: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3