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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004824
Report Date: 08/04/2026
Date Signed: 08/04/2026 11:31:58 AM

Document Has Been Signed on 08/04/2026 11:31 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:TERRA SAN FRANCISCO PRESCHOOLFACILITY NUMBER:
384004824
ADMINISTRATOR/
DIRECTOR:		SULLIVAN, SHAUNAFACILITY TYPE:
860
ADDRESS:3801 BALBOA STREETTELEPHONE:
(415) 906-2220
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 84TOTAL ENROLLED CHILDREN: 21CENSUS: 20DATE:
08/04/2026
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:19 AM
MET WITH:Shauna Sullivan (S1) and Wendy Xa (S2)TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On August 4, 2026, Licensing Program Analysts (LPAs) Leong and Garcia arrived at the facility to conduct an unannounced case management inspection regarding the Action Level Exceedance (ALE) of lead in the Child Care Center’s water. S2 was present during today’s visit. LPAs met with S1 and S2 and explained the purpose of the visit.

There were 20 preschool-aged children and 4 staff members present at the facility.

LPAs discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires lead testing of water in Child Care Centers. LPAs reviewed with S1 that 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 thereafter.

The facility received the ALE report from the vendor on May 13, 2026. Test results indicated that two fixtures (C and I) exceeded the allowable limit of 5.4 parts per billion (ppb).

According to S1, fixture I will be retested, and fixture C will be permanently removed. In the meantime, the facility will use other fixtures that have passed lead testing for food preparation and drinking.

LPAs observed that the water supply to the affected fixtures had been shut off and was inaccessible to children. LPAs also observed “do not use” signs on both fixtures. LPAs advised S1 to continue complying with ALE remediation requirements and to maintain documentation to verify the correction.

Please see the next page for today’s deficiency.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Shauna Sullivan.

Garfield Leung
Hanson Leong
DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/04/2026 11:31 AM - It Cannot Be Edited


Created By: Hanson Leong On 08/04/2026 at 10:18 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: TERRA SAN FRANCISCO PRESCHOOL
FACILITY NUMBER: 384004824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2026
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 director stated that fixture "I" will be retested and that fixture "C" will be permanently removed.

Fixture "C" was observed being worked on by a plumber.
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Based on results received from the certified water samplers, the facility exceeded 5.4 parts per billion (ppb) of lead in its water source. This level is above the allowable threshold and presents a potential health, safety, or personal rights risk to children in care.
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LPA Leong requested that the facility notify the office once both fixtures are corrected. A Plan of Correction (POC) visit will be required to clear the deficiency,

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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.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Hanson Leong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2026


LIC809 (FAS) - (06/04)
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