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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003094
Report Date: 03/29/2024
Date Signed: 03/29/2024 01:18:16 PM


Document Has Been Signed on 03/29/2024 01:18 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SEABIRD PRESCHOOLFACILITY NUMBER:
384003094
ADMINISTRATOR:CHAN, MEIFACILITY TYPE:
850
ADDRESS:9 PELTON PLACETELEPHONE:
(415) 932-6023
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY:61CENSUS: 19DATE:
03/29/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Meina ChanTIME COMPLETED:
01:30 PM
NARRATIVE
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On March 29, 2024 at approximately 11:30am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit regarding Lead Testing in the drinking water and met with Site Director Meina Chan during the visit. Purpose of the inspection was explained. There were 19 children 6 staff members including the Site Director present during today's visit. Facility's managers Yulia and Peter Iskandar arrived at facility to discuss with LPA about the lead testing requirement.

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 before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Based on the file review, facility did not conduct lead testing on their drinking water before January 1, 2023 pursuant to the Written Directive. Facility conducted lead testing with the San Francisco Water Power Sewer on January 20, 2024. Due to not conducting the lead testing by the due date and test results are not yet uploaded on the State Waterboard website pose a potential health and safety risks to persons in care. Type B deficiency has been issued on this day. See LIC 809D.

A copy of this report was discussed and left with the Site Director whose signature on this form confirmed receipt of these report. Notice of Site Visit was provided. Notice to remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
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 01:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SEABIRD PRESCHOOL
FACILITY NUMBER: 384003094

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2024
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 is not met as evidenced by:
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Facility Representative will reach out to vendor for results to be uploaded to the waterboard website.
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Based on record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
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Per Written Directive, Lead Testing Results will need to be forwarded to Licensing Office along with LIC 9275, LIC 9276, Facility Sketch and technician must upload results to State Waterboard Site.

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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
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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