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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004417
Report Date: 03/25/2024
Date Signed: 03/27/2024 01:38:02 PM


Document Has Been Signed on 03/27/2024 01:38 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/26/2024 08:09 AM

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

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On March 25th,2024 Licensing Program Analyst (LPA) Kassandra Medrano conducted an unannounced, case management inspection regarding lead testing for childcare centers. LPA met with Rey Lowe, Site Director and explained the purpose of the inspection. Present during visit included 13 children and 5 staff.

During visit LPA spoke to Tal Tamir, Administrator, who provided LPA Medrano with documentation of lead sampling results that were completed on 7/8/2022. Per document reviewed facility tested under 5.5 ppb on faucets tested. During review of water board website there was no documentation found for the facilities sampling. LPA discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 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.

Based on documentation obtained, there was no license number printed on sample report. Administrator to follow up with vendor, and have vendor update the samples to online website. As well as post sampling results for public review.

A notice of site visit was given and must remain posted for 30 days. No deficiencies were cited during today's inspection. Exit interview conducted and report was reviewed with the Facility representative, Rey Lowe.

******THIS REPORT HAS BEEN AMENDED: AN 809-D HAS BEEN CREATED IN ERROR*******
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
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 03/27/2024 01:38 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/26/2024 08:09 AM

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: NEWTON AT UPPER LAUREL(MENLO PARK CITY SCHOOL DIS)
FACILITY NUMBER: 414004417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2024
Section Cited
HSC
00000

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THIS DOCUMENT WAS CREATED IN ERROR.
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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: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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