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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001721
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:25:43 PM

Document Has Been Signed on 09/10/2024 04:25 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: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: 4DATE:
09/10/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Pilar RendonTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On 9/10/2024 at 3:30PM, 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 Lead Teacher, Pilar Rendon and explained purpose of the inspection. Present were 3 staff supervising 4 children. LPA inspected facility for health and safety hazards.

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 vendor. Test results for this facility show an exceedance level higher than the allowable, 5.4 ppb for four water fixtures. Fixtures with exeedances have been identified as: ‘O’, ’N’, ’L’, and ‘C’.

Per lead teacher affected fixtures have been ‘turn off’, and are not is use until pending repair and retesting is complete.

During inspection, LPA obtained the copy of Facility Sketch/ map (LIC999).
LPA request several documents from facility including the: External Water Sampler Self-Certification Form (LIC9275), and Child Care Center Sampling Checklist (LIC9276).

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 case management report was discussed with Lead Teacher, Pilar Rendon. Staff’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. Staff 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: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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 09/10/2024 04:25 PM - It Cannot Be Edited


Created By: Luis Gomez On 09/10/2024 at 03:51 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: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
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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Facility will cease immediately the use of affected fixtures, from all childcare operations. Facility will ensure fixtures (O, N, L, C) are replaced and retested prior to the due date: 9/30/2024.
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Based on results received from the certified water sampler, facility fixtures tested (O, N, L, C) exceeded the allowable 5.4 ppb of lead from their water source.This poses a potential health and safety 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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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