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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000931
Report Date: 11/15/2023
Date Signed: 11/15/2023 03:55:50 PM


Document Has Been Signed on 11/15/2023 03:55 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:IHSD, INC-SOUTH SAN FRANCISCO HEAD START CENTERFACILITY NUMBER:
414000931
ADMINISTRATOR:YESSENIA FLORES-GUZMANFACILITY TYPE:
850
ADDRESS:825 SOUTHWOOD DRIVETELEPHONE:
(650) 368-1728
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:80CENSUS: 20DATE:
11/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Eulalia MatthewsTIME COMPLETED:
04:10 PM
NARRATIVE
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On November 15, 2023, Licensing Program Analyst (LPA) Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with assistant site manager, Eulalia Matthews. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 20 children, with 13 staff members during outdoor playtime.

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 January 30, 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 barricaded and or made the affected fixture inaccessible and put up signs for children. The affected fixtures in this facility are fixtures G (5.8) and H (7.6), which are outdoor faucets that are used only for watering the plants. Per director, the facility is using other water sources that passed the lead water testing for food preparation and ingestion/refill. The facility also has "Big Berkey" and "Alhambra" water services available for drinking or food preparation.

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 Deficiency

This report was reviewed and signed by assistant site manager, Eulalia Matthews.

This notice of Site visit was 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: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/15/2023 03:55 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: IHSD, INC-SOUTH SAN FRANCISCO HEAD START CENTER
FACILITY NUMBER: 414000931

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
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 included signs indicating that the fixtures are not for drinking. The facility states they only use fixtures G and H for watering plants. Management will decide whether to permanently remove or retest the affected fixtures.
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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. This pose a potential health, safety, or personal rights risk to persons in care.
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The facility will update LPA of the retest results or premanent removal of the fixtures by set due date.

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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: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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