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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005286
Report Date: 01/09/2024
Date Signed: 01/09/2024 10:46:41 AM

Document Has Been Signed on 01/09/2024 10:46 AM - 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:MISS NICKY'S PRESCHOOL & TODDLER CENTERFACILITY NUMBER:
214005286
ADMINISTRATOR:AMANDA MOSHERFACILITY TYPE:
850
ADDRESS:159 MERRYDALE ROADTELEPHONE:
(415) 472-4777
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 21DATE:
01/09/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amanda MosherTIME COMPLETED:
10:50 AM
NARRATIVE
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On 1/9/2024, Licensing Program Analyst (LPA) Hanson Leong made an unannounced case management visit to the child care center listed above. The purpose of today's visit is to conduct an inspection of the Action Level Exceedance (ALE) of lead in the water at the Child Care Center. The LPA was granted entry by the Director, Amanda Mosher. Ms. Mosher was informed of the reason for today's visit by the LPA. Present in the center includes four staff members, 19 preschool-aged children and 2 toddlers. All individuals listed on the center's roster were authorized to work or be present in the child care center. The center was operating within its capacity and in accordance with the required staff-to-children ratio.

LPA discussed with the director regarding the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the Lead Testing of water in the Child Care Center. 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 Vendor's ALE report for the center was received on 11/19/2023. The test results indicate that the center's parts per billion (ppb) exceeded the acceptable limit of 5.5 ppb. In response to this finding, the center took proactive measures by hiring a licensed plumber to replace the fixture. According to the director, fixture B with a 12 ppb has been replaced. According to the director, she is coordinating with the Lead Water vendor to return to the center and retest the water again. The LPA observed the director contacting the Lead Water vendor and mentioned that they were waiting for the results to be uploaded into their system. The center has relied on alternative water sources, such as bottled water, to prepare and consume food during this period.

Please refer to LIC 809D for today’s citation.

A copy of today’s report and the center’s appeal rights were given to Amanda Mosher. A Notice of Site Visit was given to Amanda Mosher and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Amanda Mosher.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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 01/09/2024 10:46 AM - It Cannot Be Edited


Created By: Hanson Leong On 01/09/2024 at 10:25 AM
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: MISS NICKY'S PRESCHOOL & TODDLER CENTER
FACILITY NUMBER: 214005286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
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 center is waiting for the certified water samplers to return and retest the affected fixture. Once the new results are available, the center will forward them to the LPA for review.
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Based on results received from the certified water samplers, the center exceeded 5.4 ppb of lead in their water source. Once received, the center took immediate and proper actions to remediate the fixtures.
This poses a potential health, safety, or personal rights risk to children in care.

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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:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
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