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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001721
Report Date: 08/19/2024
Date Signed: 08/19/2024 04:32:33 PM

Document Has Been Signed on 08/19/2024 04:32 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:SFCCD-MISSION COMMUNITY COLLEGE CENTERFACILITY NUMBER:
384001721
ADMINISTRATOR/
DIRECTOR:		MARIA VILLASANAFACILITY TYPE:
850
ADDRESS:1125 VALENCIA STREETTELEPHONE:
(415) 920-6200
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
08/19/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Pilar RendonTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On 8/19/2024, at 3:20PM, Licensing Program Analyst (LPA) Luis Gomez met with Lead Teacher, Pilar Rendon. The purpose of today’s visit was explained and was for an unannounced, case management inspection. Present was the lead teacher and 2 staff. Per lead teacher, there are no children present. LPA inspected facility for health and safety hazards.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Based on record review, interview, and observation, LPA confirmed facility water outlets used for water consumption or food preparation have not been tested for Lead Exceedance Levels.

During inspection LPA provided facility PIN 21-21.1 CCP Release of Written Directive for Lead Testing of Water in Licensed Child Care Centers Per AB2370.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 1, Health and Safety, Code of Regulations and cited on 809D. Exit interview was discussed with Lead Teacher, Pilar Rendon, including plans for correction and evaluation report. Lead Teacher’s signature of this form acknowledges the receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. Lead Teacher was advised any additional questions to call 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: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 08/19/2024 04:32 PM - It Cannot Be Edited


Created By: Luis Gomez On 08/19/2024 at 04:17 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: SFCCD-MISSION COMMUNITY COLLEGE CENTER
FACILITY NUMBER: 384001721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2024
Section Cited
HSC
1597.16(a)(1)

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1597.16(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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Facility will ensure all water outlets used for water consumption or food preparation are tested by the due date: 9/19/2024.
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Based on record review, interview, and observation, LPA confirmed facility water outlets used for consumption or food preparation have not been tested for Lead Exceedance Levels. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.

PIN 21-21.1 CCP was provided during inspection.

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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: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024


LIC809 (FAS) - (06/04)
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