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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500506
Report Date: 07/18/2024
Date Signed: 07/18/2024 12:52:44 PM

Document Has Been Signed on 07/18/2024 12:52 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PENINSULA COVENANT PRESCHOOLFACILITY NUMBER:
410500506
ADMINISTRATOR/
DIRECTOR:		CORRALES, JENNIFERFACILITY TYPE:
850
ADDRESS:3560 FARM HILL BLVDTELEPHONE:
(650) 365-8079
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 55TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
07/18/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:59 AM
MET WITH:Ariana Thomas/Jennifer CorralesTIME VISIT/
INSPECTION COMPLETED:
01:15 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 July 18, 2024, at approximately 11:00am, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) related to lead water testing. LPA met with Lead teacher Ariana Thomas and explained the purpose of the visit. Director was in a meeting and met with LPA following meeting. Present today was Director, 2 staff and 9 preschool age children. Facility is operating within teacher/children capacity ratios today.

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 their initial ALE report from the Vendor on May 30, 2024. Test results for this facility exceeded a higher level of parts per billion (ppb) allowed 5.5 ppb. There was a fixture that tested above the threshold, fixture J (5.8 ppb). Per Director, facility ceased using it for drinking purposes. LPA observed a sign posted above sink stating, “This sink is for washing hands only”. Fixture “J” is located in bathroom in room #1 (which is currently not in use).

Director emailed LPA copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999) and water sampling results.

See LIC809-D for deficiency cited today.

This report was reviewed and signed by Director, Jennifer Corrales.

A Notice of Site Visit was provided to the Director and must remain posted for 30 days.
Marie Rodriguez
Maria Olguin-Leon
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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 07/18/2024 12:52 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 07/18/2024 at 12:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PENINSULA COVENANT PRESCHOOL
FACILITY NUMBER: 410500506

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2024
Section Cited

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:
8
9
10
11
12
13
14
Lead testing report was uploaded to database on 07/12/2024. Lead testing report indicated one fixtures "J" had high exceedance levels of 5.8 ppb.
8
9
10
11
12
13
14

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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2