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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000539
Report Date: 03/29/2024
Date Signed: 03/29/2024 02:25:20 PM

Document Has Been Signed on 03/29/2024 02:25 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CLAIRE LILIENTHAL AFTER SCHOOL PROGRAMFACILITY NUMBER:
384000539
ADMINISTRATOR:FRANK KANIOSFACILITY TYPE:
840
ADDRESS:3960 (AKA3950) SACRAMENTO STTELEPHONE:
(415) 750-1577
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 130TOTAL ENROLLED CHILDREN: 130CENSUS: 0DATE:
03/29/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Linda MarceloTIME COMPLETED:
02:30 PM
NARRATIVE
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On 3/29/2024 at 1:15PM, Licensing Program Analyst (LPA) Luis Gomez conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of lead in Child Care Center's water. LPA met with Assistant Director, Linda Marcelo and explained the purpose of today's inspection. Per assistant director, the after school program operates Monday - Friday from 3:30PM- 6:00PM. LPA inspected facility for health and safety hazards.

During inspection, LPA and assistant director discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requiring all Child Care Centers to conducted lead testing of their water. All Child Care Centers located in buildings constructed prior to January 1, 2010, must have their water tested, with results posted by January 1, 2023, and every 5 years after date of the first testing.

On 10/30/2023, the Department received facility’s ALE report from vendor. Lead test results for facility show an exceedance level of parts per billion (ppb), higher than the allowable, 5.4 ppb on water outlet (Fixture P).

At 1:30PM., LPA toured facility with assistant director. LPA observed affected fixture is no longer in use (Photo Taken). Per assistant director, fixture has been permanently removed from operation, with no plans at this time to replaced and retest at this time.

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

During today’s inspection, deficiency was observed in areas evaluated according to Title 22, Section 12 Chap 1 Ca Code of Regulations and cited on 809D. Exit interview, plan for correction, and evaluation report was discussed with Assistant Director, Linda Marcelo. The assistant director’s signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Facility was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
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 03/29/2024 02:25 PM - It Cannot Be Edited


Created By: Luis Gomez On 03/29/2024 at 02:06 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: CLAIRE LILIENTHAL AFTER SCHOOL PROGRAM
FACILITY NUMBER: 384000539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2024
Section Cited
CCR
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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LPA observed affected water outlet (Fixture P) has been removed. Per assistant director, fixture has been permanently removed from operation, with no plans at this time to replaced and retest at this time.
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Based on results received from the certified water samplers, the facility exceeded allowable ppb of lead (5.5 or greater) on tested water outlet, fixture P. This poses a potential health and safety risk to children in care.
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Deficiency has been cleared.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2024


LIC809 (FAS) - (06/04)
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