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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504700
Report Date: 10/27/2023
Date Signed: 10/27/2023 02:01:26 PM

Document Has Been Signed on 10/27/2023 02:01 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:JCCSF LOISE& CLAUDE ROSENBERG EARLY CHILDHOOD CTRFACILITY NUMBER:
380504700
ADMINISTRATOR:DOTSON, KELLYFACILITY TYPE:
850
ADDRESS:325 ARGUELLO BLVD.TELEPHONE:
(415) 386-4999
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 59TOTAL ENROLLED CHILDREN: 59CENSUS: 51DATE:
10/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:Kelly DotsonTIME COMPLETED:
02:15 PM
NARRATIVE
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On October 27, 2023, Licensing Program Analyst (LPA) Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with director, Kelly Dotson. LPA explained the purpose of the visits and was given a tour of the facility.
Present in facility are 51 children, with 14 staff members including the director.

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 April 6, 2023. 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. The affected fixtures are A(6.7), G(26), and K(7.8). Per director, fixtures A, G and K had filters installed and retested. The results for fixture G(4 ppb) on May 20, 2023 and fixtures A and K are retested on September 21, 2023. Fixture A retested above the threshold again at 6.4 ppb of lead from the September retest date. Fixture K passed the retest at 2.8 ppb of lead. Therefore, fixtures G and K are now in compliance for allowable amount of lead in water. LPA spoke to Belen Bohan, facilities project manager for all JCCSF sites. Per Belen, fixture A is currently out of order and they got quotes from different contractors to replace the affected fixture before they schedule for a retest with the certified water samplers. The facility is using water services/other water sources that passed the lead water testing for refill, ingestion or food preparation.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), given to the LPA.

* See next page for deficiencies cited today

This report was reviewed and signed by Director, Kelly Dotson.

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: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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 10/27/2023 02:01 PM - It Cannot Be Edited


Created By: Nathan Garcia On 10/27/2023 at 01:37 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: JCCSF LOISE& CLAUDE ROSENBERG EARLY CHILDHOOD CTR
FACILITY NUMBER: 380504700

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2023
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 are in the process of replacing the affected fixture 'A'. Once replaced, the facility will contact the certified water samplers for a retest. Once retest results are available, the facility will forward them to the LPA for verification.
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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. This pose a potential health, safety, or personal rights risk to persons in care.
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Retest results will be forwarded to LPA by set due date.

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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: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


LIC809 (FAS) - (06/04)
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