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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001949
Report Date: 08/26/2024
Date Signed: 08/26/2024 10:41:51 AM

Document Has Been Signed on 08/26/2024 10:41 AM - 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:POTRERO KIDS AT DANIEL WEBSTERFACILITY NUMBER:
384001949
ADMINISTRATOR/
DIRECTOR:		OZUNA, YARENAFACILITY TYPE:
850
ADDRESS:465 MISSOURI STREETTELEPHONE:
(415) 625-9578
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94107
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 34DATE:
08/26/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:04 PM
MET WITH:Yarena OzunaTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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On August 26, 2024, Licensing Program Analyst (LPA) Van conducted an unannounced case management inspection and met with the Director Yarena Ozuna. 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. Present today were Director, Site Supervisor, 7 teachers, and 34 children in care.

Based on review of California water board website, facility had not conducted test and received passing scores. During visit LPA observed that results had not been posted for public display. Today a type B deficiency is being cited due to the facility not having results by or before 1/1/2023. LPA referred facility representative to the Department website for lead: Toxicity Prevention and Water Testing Information.

Director was asked to keep the department updated with test results, submit/post supporting documents such as External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), and Facility Sketch (LIC999).

Today's report, 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.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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 08/26/2024 10:41 AM - It Cannot Be Edited


Created By: Sheran Lo On 08/26/2024 at 10:21 AM
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: POTRERO KIDS AT DANIEL WEBSTER
FACILITY NUMBER: 384001949

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
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 is not met as evidenced by:
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The lead water results must be uploaded onto the water sampling portal by the laboratory, and supporting documents, such as LIC 999, LIC 9275, and LIC 9276, must be submitted to the department by the above-due date.

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Based on the interview with the director, the licensee did not comply with the section cited above, which poses a potential risk to the health, safety, or personal rights of children in care.
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The deficiency cited today will be cleared once the results are uploaded onto the water sampling portal by the laboratory.

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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:Sheran Lo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024


LIC809 (FAS) - (06/04)
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