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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004601
Report Date: 04/27/2023
Date Signed: 04/27/2023 01:21:11 PM

Document Has Been Signed on 04/27/2023 01:21 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:SFUSD-GEORGE WASHINGTON CARVER ELEMENTARY SCHOOLFACILITY NUMBER:
384004601
ADMINISTRATOR:LEWIS, CATHERINEFACILITY TYPE:
850
ADDRESS:1360 OAKDALE AVENUETELEPHONE:
(415) 330-1540
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: DATE:
04/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Catherine LewisTIME COMPLETED:
01:35 PM
NARRATIVE
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On April 27, 2023 at 12:15 PM, Licensing Program Analyst (LPA) April Cowan conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the director, Catherine Lewis for this inspection. The purpose of the inspection was explained.

Present director, 14 staff, and 49 children in care.

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 10/15/22. 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 plastic covers over faucets indicating that the water fountain fixtures are not to be used. LPA observed that there were no signs posted at the faucets used for hand washing only, and LPA informed director that signs should be posted at each faucet. The facility took action to repair and replace fixtures. Per director, all faucets have been replaced and retested. The results continue to measure an exceedance.

Director states that she is not sure of the next step as the facility is a part of the San Francisco School District. The facility has a water a water dispenser for children to drink. Director is instructed to let Licensing know of next steps and progress.

Due to difficulties with printer, this report is emailed to site director with a request for reply demonstrating receipt.

* See next page for deficiency cited today
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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 04/27/2023 01:21 PM - It Cannot Be Edited


Created By: April Cowan On 04/27/2023 at 01:10 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: SFUSD-GEORGE WASHINGTON CARVER ELEMENTARY SCHOOL
FACILITY NUMBER: 384004601

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2023
Section Cited

101700.3(b)(1)

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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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Director will provide the new test results to LPA no later than 10/24/2022.
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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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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 Leung
LICENSING EVALUATOR NAME:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
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