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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410506032
Report Date: 11/03/2023
Date Signed: 11/03/2023 12:50:37 PM


Document Has Been Signed on 11/03/2023 12:50 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:REDWOODS INTERNATIONAL MONTESSORI, THEFACILITY NUMBER:
410506032
ADMINISTRATOR:LILES, ANNAGI S.FACILITY TYPE:
850
ADDRESS:2000 WOODSIDE ROADTELEPHONE:
(650) 366-9859
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:48CENSUS: 21DATE:
11/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Janice MorimotoTIME COMPLETED:
01:05 PM
NARRATIVE
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On 11/3/2023, at approximately 12:15PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) for lead in the Child Care Center's water. LPA was granted entry to the facility by Director, Janice Morimoto. Present in the facility are 3 staff and 21 preschool-age children.

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 December 29, 2022. Test results for this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. Per director, the affected fixture C (6.9) is a water fountain located in back outdoor play area. The facility has covered the fixture and posted a sign stating not to use it. The facility is using water from fixtures that do not have exceedances for water ingestion or refill. The facility has not been able to replace or remove the fixture as they require building management to repair or modify the fixture. They are awaiting coordination with building management to remediate the fixture.

See LIC809-D for deficiency cited today.

This report was reviewed and signed by Director, Janice Morimoto.

A Notice of Site Visit was provided to the Director and must remain posted for 30 days.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023
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 11/03/2023 12:50 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: REDWOODS INTERNATIONAL MONTESSORI, THE
FACILITY NUMBER: 410506032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
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 will contact building management to coordinate remediation of the affected fixture. Facility will submit plans to fix the fixture to LPA. Facility will submit photos of the remediated fixture to LPA.
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Based on record review of the lead testing results from water samplers, the facility exceeded 5.4 ppb of lead in one of their water fixtures. The fixture has been covered and has a sign posted stating it is not for use. The fixture has not been removed or replaced.
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Director will submit proof of correspondence and plan of action with building management to LPA by 12/4/2023.

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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023
LIC809 (FAS) - (06/04)
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