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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002750
Report Date: 11/15/2023
Date Signed: 11/15/2023 01:59:19 PM


Document Has Been Signed on 11/15/2023 01:59 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:BUILDING KIDZ OF SSF, INC. (INFANT)FACILITY NUMBER:
414002750
ADMINISTRATOR:JAQUELINE GALDAMEZFACILITY TYPE:
830
ADDRESS:600 GRAND AVENUETELEPHONE:
(650) 837-9348
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:25CENSUS: 7DATE:
11/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:04 PM
MET WITH:Ana GaldamezTIME COMPLETED:
02:10 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. In conjunction with the ALE exceedance in the preschool license number 414002749 for ALE fixtures 'A', 'C', 'D' and 'H'. Both licenses 414002750 (infant) and 414002749 (preschool) are located in the same building. LPA met with director, Ana Galdamez. LPA explained the purpose of the visits and was given a tour of the facility. The two licenses' water was tested for lead on January 18, 2023. Both facility licenses are present in facility sketch for the lead water testing documents.
Present in facility are 7 children, with 2 staff members during nap time.

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 February 6, 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 for children. The affected fixtures under this license is fixture E (5.5), which is a diaper changing table fixture located in the infant classroom 1. According to the director, fixture 'E' has been permanently removed around May. LPA observed and confirmed that the fixture 'E' has been permanently removed prior to the visit. Per director, the facility is using other water sources that passed the lead water testing for food preparation and ingestion/refill. The 'Brita' water pitchers being used have lead specific filters installed.

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.

Deficiency will be cited and cleared on the same visit.

This report was reviewed and signed by Director, Ana Galdamez.

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 01:59 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: BUILDING KIDZ OF SSF, INC. (INFANT)
FACILITY NUMBER: 414002750

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 permanently removed fixtures D and E and fixtures A,C, and H have been replaced. The facility will contact the certified water samplers to schedule for a retest. Fixture 'E' has been remediated under this license number due to the permanent removal.
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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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Deficiency will be cited and cleared on the same visit.

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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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