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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002020
Report Date: 03/04/2024
Date Signed: 03/04/2024 05:03:02 PM


Document Has Been Signed on 03/04/2024 05:03 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 MENLO PARK-MENLO CHILDREN'S CTR-PRESCHOOLFACILITY NUMBER:
414002020
ADMINISTRATOR:CHAW, SHERIANNFACILITY TYPE:
850
ADDRESS:801 LAUREL STREETTELEPHONE:
(650) 330-2260
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:72CENSUS: 18DATE:
03/04/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Director, Sheriann ChawTIME COMPLETED:
05:15 PM
NARRATIVE
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On March 4th, 2024 at approximately at 3:30pm, Licensing Program Analyst (LPAs) Tapia-Mandujano and Zaragoza conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with Director, Sheriann Chaw. LPAs explained the purpose of the visits and inspected the facility for health and safety hazards. Present in facility are Director and 4 staff supervising 18 preschool age children (3 toddlers). Facility is within ratio capacity on this day. During the inspection, all adults working in the facility have fingerprint clearance and are associated.

LPAs 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 February 20th, 2024. 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 out of order. The affected fixtures are A(5.7), G(15), and H(12) parts per billion (ppb) of lead. Per director, fixture A, G, and H are hand washing sinks located in the classrooms. LPAs also observed that the facility uses water services for food preparation using the adult sinks in the classrooms.

LPA Tapia-Mandujano received through email copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999).

Type B deficiency was cited today under CCR, Tittle 22, Division 1.

A Notice of Site Visit was provided. An exit interview was conducted and report was reviewed and provided to the Director, Sheriann Chaw.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
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 03/04/2024 05:03 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 MENLO PARK-MENLO CHILDREN'S CTR-PRESCHOOL
FACILITY NUMBER: 414002020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2024
Section Cited

101700.3(b)(1)

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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 fixtures will be remediated and retested. The facility will update LPA for scheduled retest date and results will be forwarded to LPA for verification.
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Based on results received from the certified water samplers, the facility exceeded 5.5 ppb of lead in their water source in faucets A, G, and H. This pose a potential health, safety, or personal rights risk to persons in care.
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The facility will notify LPA of the retest results 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: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
LIC809 (FAS) - (06/04)
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