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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002291
Report Date: 12/19/2024
Date Signed: 12/19/2024 09:59:46 AM

Document Has Been Signed on 12/19/2024 09:59 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ALPHA KIDS ACADEMY, LLCFACILITY NUMBER:
384002291
ADMINISTRATOR/
DIRECTOR:		RACHAEL ROCHA,DIRFACILITY TYPE:
850
ADDRESS:175 JUNIPERO SERRA BLVDTELEPHONE:
(415) 664-8080
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 53TOTAL ENROLLED CHILDREN: 52CENSUS: 40DATE:
12/19/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Director, Rachael RochaTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 12/19/2024, at approximately 8:50AM, Licensing Program Analysts (LPAs) Jonathan Tse and Diana Alvarado conducted an unannounced case management visit regarding an exceedance of lead at the facility. LPAs met with Director, Rachael Rocha (D1). Licensee Natella Shtern (L1) arrived at 9:20AM. LPAs explained the purpose of the visit. Present during the visit was L1, D1, eight teachers, and 40 preschool age children.

LPAs discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the Lead Testing of water in the Child Care Center with L1 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 submitted a lead testing attestation in 2023 stating that they do not use any fixtures for consumption or for food preparation. The facility initially tested its water for lead on 12/3/2024.

Results for lead testing were uploaded on 12/11/2024. Test results for two fixtures in this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb, which are fixtures B(10.0ppb) and C(14.0ppb). Both fixtures are handwashing sinks located in a facility bathroom, and are not used for food preparation or consumption. LPAs discussed lead testing requirements with L1. LPAs provided clarification on requirements to test fixtures. Sinks used only for handwashing are not to be tested for lead. L1 stated that they understood. LPAs provided a copy of the Written Directives specified in PIN 21-21_1-CCP.

LPAs informed L1 that a deficiency would be cited and cleared on this day, due to the tested fixtures being used exclusively for handwashing only. L1 stated that they understood. LPAs received a copy of the lead testing report during the visit.

See LIC809-D for deficiency cited and cleared today for lead water testing. Appeal rights were provided and explained to L1. A notice of site visit was provided and must be posted for 30 days. Exit interview conducted and report was reviewed with Licensee, Natella Shtern.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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 12/19/2024 09:59 AM - It Cannot Be Edited


Created By: Jonathan Tse On 12/19/2024 at 09:07 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: ALPHA KIDS ACADEMY, LLC
FACILITY NUMBER: 384002291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited

101700.3(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.
This requirement was not met as evidenced by:
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LPAs observed that the three fixtures tested (A, B, and C) are sinks located in bathrooms and are only used for handwashing. No sinks or fixtures are used for food preparation or water consumption at this facility. This deficiency shall be cited and cleared the same day of the visit, 12/19/2024.
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Based on record review and observation, Licensee did not comply with the above by having an exceedance of lead in fixtures tested. This posed a potential risk to the health, safety, or personal rights of 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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


LIC809 (FAS) - (06/04)
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