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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518747
Report Date: 06/14/2023
Date Signed: 06/14/2023 01:35:00 PM


Document Has Been Signed on 06/14/2023 01:35 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:RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOLFACILITY NUMBER:
410518747
ADMINISTRATOR:PENA, ROXANAFACILITY TYPE:
850
ADDRESS:701 CHARTER ST, PORT 1,2,3,& 4TELEPHONE:
(650) 482-2407
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:105CENSUS: 56DATE:
06/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Site Supervisor, Roxana PenaTIME COMPLETED:
11:30 AM
NARRATIVE
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On June 14th, 2023 at approximately 9:30am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, case management inspection to RCSD- Hoover State Preschool for the Action Level Exceedance (ALE) of Lead in child Care Center's water. LPA met with Site Supervisor, Roxana Pena and explained the purpose of the visit. Present in the facility are Site Supervisor and 10 staff caring for a total of 56 preschool age children within the four classrooms. All adults working in the facility are fingerprint cleared through the School District. Facility is currently operating within teacher to child ratio on this date.

Program operates in classrooms #CDC1, #CDC2, CDC 3 and #CDC4 on the Hoover Elementary School campus. Room #CDC3 operates AM session 9a-12p and PM session 2p-5p, M-F, following the School District Calendar (Aug-June); #CDC1, #CDC2, and #CDC4 operates 8a-4p, M-F, year-round with periodic breaks throughout the year.

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 Site Supervisor, Roxana Pena and conducted a health and safety check at the facility 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.


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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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 3


Document Has Been Signed on 06/14/2023 01:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL
FACILITY NUMBER: 410518747

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2023
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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The facility has closed and covered water fixtures, included signs, and will put in a work order to permately remove the water fixtures.

Facility will submit pictures of the water fixtures permantely removed by 7/14/23.

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Based on observation, interview, and record review, the facility did not ensure to maintain a level to be under 5.5 ppb at fixtures used for drinking and food prepration. 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL
FACILITY NUMBER: 410518747
VISIT DATE: 06/14/2023
NARRATIVE
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The facility received the ALE report from the Vendor on 05/16/2023. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The faucets that exceeded in lead are located in #CDC2, #CDC4, and the water fountain in the yard outside of #CDC2. The facility was proactive in getting facility faucets and sinks tested. As LPA was inspecting the water fixtures, LPA observed that the water fixtures/fountains in #CDC4 and water fountain in the Yard outside #CDC2 are completely shut off. The faucet in #CDC2 is on. Per Lead teacher in #CDC2, that faucet is not used for drinking and/or prepping food. As LPA was inspecting, school maintenance came out to shut off faucet in #CDC2 and placed locked covers on top of the water fixture/fountain temporarily.

Per Facility, water fixtures will not be used for at all. Per Site Supervisor, a work order will be put in to permanently remove the water fixtures/fountain. The facility took action to contact the facility's management to repair and blocked fixtures/faucets, as well as work to put up signs until fixtures are completely removed.

Due to the action taken and per conversation of water fixtures not being used for those faucet that exceeded a higher level of lead facility will not be retesting. Please refer to LIC 809D for citation. Appeal rights will be provided.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor, Roxana Pena.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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