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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410507028
Report Date: 11/03/2023
Date Signed: 11/03/2023 03:15:54 PM

Document Has Been Signed on 11/03/2023 03:15 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NEIGHBORHOOD KIDS' CORNERFACILITY NUMBER:
410507028
ADMINISTRATOR:DAN RISKFACILITY TYPE:
840
ADDRESS:225 CLIFFORD AVENUETELEPHONE:
(650) 208-9874
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 14DATE:
11/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Dan RiskTIME COMPLETED:
03:40 PM
NARRATIVE
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On 11/3/2023, at approximately 2:10PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) in regards to lead in the Child Care Center's water. The facility is located within the grounds of Clifford Elementary School. LPA was granted entry into the school site by a member of the office staff. LPA met with Director, Dan Risk, and explained the purpose of the visit. Present during the visit were seven staff members and 14 preschool-age children.

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 their initial ALE report from the Vendor on August 17, 2023. Test results for this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. There were three fixtures that held an exceedance: A(6.3ppb), C(11.0ppb), and E(6.2ppb). The facility had retested two fixtures on 10/12/2023, and fixture C had retested with 4.2ppb.

Per director, all affected fixtures had been covered and restricted from use after the initial test on 8/17/2023. According to director, covers and signs restricting use of affected fixtures had all been removed about two weeks ago. The two remaining affected fixtures have not been retested and have to be remediated.

Director stated that he would send LIC9275, LIC9276, and LIC999 to LPA.

See LIC809-D for deficiencies cited today.
This report was reviewed and signed by Site Director, Dan Risk.
A Notice of Site Visit was provided to the Director and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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 2
Document Has Been Signed on 11/03/2023 03:15 PM - It Cannot Be Edited


Created By: Jonathan Tse On 11/03/2023 at 02:54 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: NEIGHBORHOOD KIDS' CORNER
FACILITY NUMBER: 410507028

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2023
Section Cited
HSC
1597.17(a)(1)

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(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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The facility tested for lead on August 11,2023.
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Based on record review, the facility did not comply with the above by not testing for lead before January 1, 2023. This posed a potential health, safety, or personal rights risk to persons in care.
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Deficiency will be issued and cleared the same day of visit, 11/3/2023.
Type B
12/04/2023
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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Director will send LIC forms 9275, 9276, and 999 to LPA. Director will communicate process of lead water testing with licensing office, and submit proof of remediated fixtures to LPA.
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Upon record review of the water sampler datebase, LPA confirmed that two water fixtures had an ALE exceedance and were not retested. There is no confirmation that the exceedances were remediated.
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Deficiency issued on 11/3/2023, and POC due date set for 12/4/2023.
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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023


LIC809 (FAS) - (06/04)
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