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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004288
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:27:41 PM


Document Has Been Signed on 03/07/2024 03:27 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:MILESTONE ACADEMY PRESCHOOL ONEFACILITY NUMBER:
414004288
ADMINISTRATOR:WIN, KAY K AND WIN, PHYU NFACILITY TYPE:
850
ADDRESS:164 SCHOOL STREETTELEPHONE:
(650) 994-2020
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:20CENSUS: 4DATE:
03/07/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Phyu Win & Kay WinTIME COMPLETED:
04:10 PM
NARRATIVE
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On March 7, 2024 at approximately 2:20pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management visit in regards to Action Level Exceedance (ALE) of lead in a childcare center's water. LPA met with director, Phyu Win, and explained the purpose of the visit.

Present during visit included director, lead teacher and 4 preschool children. Staff present have fingerprint clearance on file. Facility is operating within capacity limits and ratio during LPA's visit.

Food service is provided at center that is prepared in facility kitchen. Per director, children's families have the option to bring their own food. Children have access to drinking water through their individual water bottles that can be refilled through water fixtures on site.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

In November 2022, facility completed lead water testing requirements prior to due date. Fixtures tested included a water fountain located in classroom, kitchen sink and refrigerator drinking filter. Department received ALE results on 12/12/2022. Test results for this facility included a water fixture (water fountain) that exceeded a high level of parts per billion (ppb) allowed (5.5ppb).

The facility was proactive in permanently remediating affected fixture. Per director, affected fixture had not been used since the pandemic. Director removed water fountain from classroom. There is another sink in classroom that is utilized for hand washing only. Children have access to water in facility through non-affected fixtures.

Facility is being cited a Type B citation for lead level exceedance. Due to affected fixture being removed from facility, deficiency is cleared on the same date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the director, Phyu Win.

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/07/2024 03:27 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: MILESTONE ACADEMY PRESCHOOL ONE
FACILITY NUMBER: 414004288

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2024
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 facility took immediate action to remediate the affected fixture by removing it from facility.
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Based on observation, interview and record review, a water fixture in facility exceeded a 5.5ppb lead level which poses a potential health, safety or personal rights risk to persons in care.
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Drinking water is available to children through a non-affected water fixture.

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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) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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