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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005259
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:57:52 PM

Document Has Been Signed on 10/19/2023 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MARIN DAY SCHOOLS - TAM VALLEY CAMPUSFACILITY NUMBER:
213005259
ADMINISTRATOR:CARRIE MOEHNKEFACILITY TYPE:
840
ADDRESS:350 BELL LN. EDS BUILDING A,BTELEPHONE:
(415) 388-8304
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: DATE:
10/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:33 PM
MET WITH:Carrie MoehnkeTIME COMPLETED:
04:20 PM
NARRATIVE
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On October 19, 2023, Licensing Program Analysts (LPAs) Garcia and Tse conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPAs met with site director Carrie Moehnke. LPAs explained the purpose of the visit.
Present in facility are 22 children, with 3 staff members, including the director.

LPAs 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 11/10/2022. 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 putting signs indicating that the water fountain/kitchen fixture is not for drinking and or currently out of order. Per director, the affected fixture A (6.8) has been replaced on 12/16/2022 and retested on 12/29/2023 and received the retest results for that fixture at 3.6ppb and less than 1 ppb after running for 30 seconds. The retest was done before the January 1, 2023 deadline. LPA observed that fixture A is a sink located in the class room. The facility is using other sources of water, sink that passed the tests, for food preparation and water ingestion such as a Brita filter refilled through the school's main water dispenser.

The facility was not initially cited for the action level exceedance during the lead case management visit on October 4,2023. Due to updated guidance on the written directives in the PIN 21-21.1-CCP, the facility will be cited for the action level exceedance of the fixture. However, the facility has removed the affected fixture before the lead case management visit and the citation given today will be cleared on the same day.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), have been sent in an email to the LPA.

* See next page for deficiencies cited and cleared today.

This report was reviewed and signed by Site Director, Carrie Moehnke.

This notice of Site visit was provided to the licensee and must remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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 10/19/2023 03:57 PM - It Cannot Be Edited


Created By: Nathan Garcia On 10/19/2023 at 03:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARIN DAY SCHOOLS - TAM VALLEY CAMPUS
FACILITY NUMBER: 213005259

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2023
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 replaced the affected fixture on 12/16/22 and retested on 1/29/23. The retest results show 3.6 ppb of lead, which falls below the 5ppb threshold.
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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. Once received, the facility took immediate and proper actions to remediate the fixtures.
This posed a potential health, safety, or personal rights risk to persons in care.
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Deficiency 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 Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
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