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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505461
Report Date: 09/26/2023
Date Signed: 09/26/2023 01:40:36 PM

Document Has Been Signed on 09/26/2023 01:40 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:POMEROY RECREATION & REHABILITATION CENTERFACILITY NUMBER:
380505461
ADMINISTRATOR:SNYDER, MATHEW, DIRECTORFACILITY TYPE:
840
ADDRESS:207 SKYLINE BLVD.TELEPHONE:
(415) 665-4100
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: 0DATE:
09/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Mathew SnyderTIME COMPLETED:
01:45 PM
NARRATIVE
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On September 26, 2023., Licensing Program Analyst (LPA) Van conducted an unannounced case management inspection and met with the site Director, Mathew Snyder. The inspection aimed to discuss 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 located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every five years after the first testing date.

Based on the annual inspection conducted on June 20, it was found that the Center was in a building that was constructed before January 1, 2010, which, according to the Written Directive, required its drinking water to be tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023. However, as testing was not completed by the Center prior to the deadline, a type B deficiency was cited. See LIC 809D on the next page.

Today's report, September 26, 2023, appeal rights, and notice of the site were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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 09/26/2023 01:40 PM - It Cannot Be Edited


Created By: Brendon Van On 09/26/2023 at 12:14 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: POMEROY RECREATION & REHABILITATION CENTER
FACILITY NUMBER: 380505461

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
HSC
1597.16(a)(1)

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1597.16(a)(1) (a) (1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement was not met as evidenced by:
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The Director states that the Center has scheduled a water lead testing for September 30, 2023. Once completed, the Center will send the test result to the Licensing office.
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Based on interview and record review, the Center did not comply with the section cited above in the facility has not yet tested water for lead which poses a potential health, safety or personal rights risk to persons 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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
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