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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002689
Report Date: 05/08/2024
Date Signed: 05/08/2024 12:42:45 PM


Document Has Been Signed on 05/08/2024 12:42 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:MSD GEOKIDS (PRESCHOOL)FACILITY NUMBER:
414002689
ADMINISTRATOR:BOURNE, KIMFACILITY TYPE:
850
ADDRESS:345 MIDDLEFIELD RD., M/S 204TELEPHONE:
(650) 329-4236
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:62CENSUS: 51DATE:
05/08/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Chae MarshallTIME COMPLETED:
01:00 PM
NARRATIVE
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On May 8th,2024 Licensing Program Analyst (LPA) Kassandra Medrano conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) due to lead in the Child Care Center's water. LPA was granted entry to the facility by Chae Marshall, Director, the purpose of the visit was explained.
LPA discussed the Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 that requires the Lead Testing of water in the Child Care Center with the facility representative during the inspection. All Child Care Centers that are licensed 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. Director stated that a sampling was conducted 9/15/2022, and the facility conducts annual testing. Director stated that the facility was unsure whether it was the correct sampling needed for licensing. LPA advised facility to check in with sampler moving forward. LPA visited facility on 4/3/2024 and results had not been posted, but director provided LPA with documentation of completion. As well as explained to LPA that an outdoor hose bib in an off limits area was tested by mistake. On 4/19/2024 those results were uploaded to the water board website, and an ALE was observed.
The facility received the initial ALE report from the Vendor on 4/19/2024. Test results for 2 fixture(s) in this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb, during discussion LPA was informed that Fixture E and E5 are the same fixture. Fixture E (8.090). Fixture E and Fixture E5 (10.400), the fixture is an outdoor hose bib.
Per Written Directives 101700.3(b)(2), licensees shall maintain a lead value at or below 5.5 ppb in all outlets subject to testing requirements for the health and safety of children in care. Due to updated guidance on the written directives in PIN 21-21.1-CCP, the facility will be cited for the ALE of the fixture E and E5. LPA observed that lead testing results and LIC forms 9275, 9276 and 999 were posted for public display.

See LIC809-D for deficiency cited and cleared on the same day of the visit, 5/8/2024.
This report was reviewed and signed by Director, Chae. A Notice of Site Visit was given and must be posted for thirty days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
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 05/08/2024 12:42 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: MSD GEOKIDS (PRESCHOOL)
FACILITY NUMBER: 414002689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2024
Section Cited

101700(b)

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(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
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Facility to mark off hose bib and not use for children in care.
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Based on record review facility had an ALE of 10.400 and 8.090. These results came from an outdoor hose bib. This poses a potential health and safety risk.
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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: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2