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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004134
Report Date: 02/15/2023
Date Signed: 02/15/2023 04:18:54 PM

Document Has Been Signed on 02/15/2023 04:18 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:AVENUES KINDERCARE, THEFACILITY NUMBER:
384004134
ADMINISTRATOR:HEMBERGER, EMILYFACILITY TYPE:
850
ADDRESS:334 28TH AVENUETELEPHONE:
(415) 221-6133
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 94TOTAL ENROLLED CHILDREN: 94CENSUS: 77DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Emily HembergerTIME COMPLETED:
04:30 PM
NARRATIVE
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On 2/15/23 at approximately 3:15PM, Licensing Program Analyst (LPA) Nathan Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the Executive Director, Emily Hemberger. The purpose of the inspection was explained.

Present in facility are 77 children, present with 11 staff members after nap time.

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 the Vendor on 11/12/2022. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The facility was proactive in getting facility faucets tested and putting signs indicating that the water fountain/kitchen fixture is not for drinking and or currently out of order. Per director, the facility had replaced 7 fixtures total, except for the other three, which parts are back ordered. Per director, she contacted the facilities manager and LPA advised director to keep the department updated on the status of the fixtures. The facility has asked the children to bring their own water from home and the bottles are replenished by using water from unaffected or filtered fixtures, as needed. The facility also uses Neptune Water Solutions for water ingestion and food preparation.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), in an email to the LPA. LPA obtained copy of the lead water testing results as well.

* See next page for deficiency cited today

This report and notice of Site visit and appeal rights were provided to the licensee and must remain posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 04:18 PM - It Cannot Be Edited


Created By: Nathan Garcia On 02/15/2023 at 03:46 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: AVENUES KINDERCARE, THE
FACILITY NUMBER: 384004134

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/30/2023
Section Cited

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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The facility has included signs, replaced 7 fixtures and waiting for 3 affected fixtures and will be flushing the water fixture until they are retested with a certified water sampler by 04/30/2023.
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Based on results received from the certified water samplers, the facility exceeded 5.5 ppb of lead in their water source. Once received, the facility took immediate and proper actions to remediate the fixtures.
This poses a potential health, safety, or personal rights risk to persons in care.
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Director will send new results to the CCL/LPA by 4/30/2023.

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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:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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