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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002878
Report Date: 02/03/2023
Date Signed: 02/03/2023 03:57:30 PM


Document Has Been Signed on 02/03/2023 03:57 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:PFS-BAYSHORE MIDWAY CDC (INF)FACILITY NUMBER:
414002878
ADMINISTRATOR:DIANA ALAMEDAFACILITY TYPE:
830
ADDRESS:45 MIDWAY DRIVETELEPHONE:
(415) 330-1717
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:24CENSUS: 0DATE:
02/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:28 PM
MET WITH:Paul BiggsTIME COMPLETED:
04:15 PM
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On 2/3/23 at 03:00PM, Licensing Program Analyst (LPA) Nathan Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the Site Director, Paul Biggs. The purpose of the inspection was explained.

There were no children or teachers present during the visit due to a foul smell, which could be caused by a critter. UIR will be sent to San Bruno RO.

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 11/9/2022. 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. Per director, they replaced the fixture on 11/28/22 and they have been flushing the faucet for three weeks, with logs. According to Paul, the recent retest was done on 1/30/23 by the certified water samplers. The infant children in that classroom have formulas brought from home and do not have access to the affected fixture. There is also another fixture that is being utilized that passed the initial test.

Director was asked to keep the department updated/send the results of the retest, once received.

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. LPA obtained copy of the lead water testing results as well.

No deficiencies will be cited for today due to another water source available in the classroom and the proactive remediation of the affected fixture.

This report and notice of Site visit is 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: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023
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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