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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500701
Report Date: 03/06/2024
Date Signed: 03/06/2024 10:04:35 AM

Document Has Been Signed on 03/06/2024 10:04 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:WOODSIDE PARENTS' NURSERY SCHOOLFACILITY NUMBER:
410500701
ADMINISTRATOR:AREVELOS, DIANAFACILITY TYPE:
850
ADDRESS:3154 WOODSIDE ROADTELEPHONE:
(650) 851-7112
CITY:WOODSIDESTATE: CAZIP CODE:
94062
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 16DATE:
03/06/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Diana ArevlosTIME COMPLETED:
10:20 AM
NARRATIVE
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On March 6, 2024 at approximately 9:00pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced, case management inspection regarding lead testing for childcare centers. LPA met with Director, Diana Arevalos, and explained the purpose of the inspection. Present during visit included 16 children and 3 teachers, and 3 volunteers.

Children have access to drinking water at facility with an accessible water pitcher and cups. The water pitcher is refilled at the facility via a filtered water faucet located in classroom sink.

LPA discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the Directorr 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.

As of this date, facility is not completed lead water testing that is in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred facility representative to the Department website for lead: Toxicity Prevention and Water Testing Information.

Facility is being cited a Type B citation for not completing lead water testing requirement prior to due date. A plan of correction was discussed, and appeal rights were provided.

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

Exit interview conducted and report was reviewed with the site supervisor, Diana Arevalos.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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 03/06/2024 10:04 AM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 03/06/2024 at 09:49 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: WOODSIDE PARENTS' NURSERY SCHOOL
FACILITY NUMBER: 410500701

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
HSC
1597.16(a)(1)

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HSC 1597.16(a)(1) A licensed child day care center... 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...

This requirement is not met as evidenced by:
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Facility to test their water fixtures used for drinking and food preparation no later than POC due date.
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Based on interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
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LPA reminded Director, testing must be completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA reminded Director that testing must be completed by an ELAP certified laboratory and uploaded to database.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024


LIC809 (FAS) - (06/04)
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