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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000455
Report Date: 09/16/2024
Date Signed: 09/16/2024 04:17:28 PM


Document Has Been Signed on 09/16/2024 04:17 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:CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUBFACILITY NUMBER:
414000455
ADMINISTRATOR:CAROLYN SHAVELFACILITY TYPE:
840
ADDRESS:2720 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 522-7440
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:42CENSUS: DATE:
09/16/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Carolyn ShavelTIME COMPLETED:
04:40 PM
NARRATIVE
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On 9/16/2024, at approximately 3:30 PM, Licensing Program Analyst (LPA) Janet Gil made an unannounced case management visit to the child care center listed above. The purpose of today's visit is to conduct an inspection regarding the Action Level Exceedance (ALE) of lead in the water at the Child Care Center. LPA met with lead teachers Jessica Lira and Heather Huffington. LPA explained the reason for the visit. Present during inspection included 34 children with 6 staff members (including director). Facility is operating within capacity requirements and ratios at time of LPA's inspection. All adults working at the facility have fingerprint clearance on file.

LPA discussed with lead teachers the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the Lead Testing of water in the Child Care Center. 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 Vendor's ALE report for the center was received on 09/09/2024. The test results indicate that the center's parts per billion (ppb) exceeded the acceptable limit of 5.5 ppb. In response to this finding, the center took proactive measures to close off sample site with exceedance. According to the lead teacher Heather Huffington, fixture C with a 8.9 ppb will be replaced by facilities building maintenance and retested. Lead Teacher will coordinate with the Lead Water vendor to return to the center and retest the water again. The center has relied on alternative water sources, such as approved water sample sites, to prepare and consume food during this period. Per lead teacher, they also use a brittle water filter to re-fill children's water bottles.

Please refer to LIC 809D for today’s citation.

A copy of today’s report and the center’s appeal rights were given to Heather Huffington. A Notice of Site Visit was given to Heather Huffington and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Heather Huffington.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
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 09/16/2024 04:17 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: CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB
FACILITY NUMBER: 414000455

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
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 center is planing to replace fixture and re test sample site C. Per lead teacher, she will reach out to certified water samplers to return and retest the affected fixture. Once the new results are available, the center will forward them to the LPA for review.
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Based on results received from the certified water samplers, the center exceeded 5.4 ppb of lead in their water source. Once received, the center took immediate and proper actions to close off the fixture.
This poses a potential health, safety, or personal rights risk to children in care.
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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