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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410503311
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:28:04 PM


Document Has Been Signed on 10/12/2023 12:28 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:MILLBRAE NURSERY SCHOOL, INCFACILITY NUMBER:
410503311
ADMINISTRATOR:BOGNI-RODRIGUEZ, BRIGIDANFACILITY TYPE:
850
ADDRESS:86 CENTER ST.TELEPHONE:
(650) 589-3028
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:44CENSUS: 26DATE:
10/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Megan Bogni-RodriguezTIME COMPLETED:
12:45 PM
NARRATIVE
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On October 12, 2023 at approximately 11:30 AM, 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 site director, Megan Bogni-Rodriguez. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 26 children, present with 9 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 October 10, 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/kitchen fixture is not for drinking and or currently out of order. Per director, the affected fixture B (9.8) is located in a backroom where the children don't have access to and the sink is only used for washing art supplies. The facility was initially not cited for the action level exceedance during the ALE case management inspection on December 2, 2022 due to the location and use of the affected fixture. Ultimately, the fixture was still tested and has an action level exceedance, therefore the facility will be cited for the fixture being above the 5.5ppb of lead in water threshold. The facility is using other sources of water, sinks that passed the tests, for food preparation and water ingestion.

According to the director and the LPA's search on the database, the facility has REMEDIATED and retested the affected fixture (B) on August 14, 2023 and passed the lead water retest at 3 ppb of lead and after 30 second flush of less than 1 ppb of lead in water. The deficiency will be given and cleared on the same visit.

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 deficiencies cited today

This report was reviewed and signed by Site director, Megan Bogni-Rodriguez.

This Notice of Site visit and Appeal Rights were provided to the Director.

Notice of Site Visit 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: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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 10/12/2023 12:28 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: MILLBRAE NURSERY SCHOOL, INC
FACILITY NUMBER: 410503311

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited
CCR
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 affected fixture in the facility is located in a room where it is inaccessible to children. The facility retested on 8/14/23 and passed the lead water testing. The facility also remidiated fixture (B) before the 10/12/23 visit.
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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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The facility will be cited and the same citation will be cleared on the same visit.

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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: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
LIC809 (FAS) - (06/04)
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