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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001649
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:16:37 PM

Document Has Been Signed on 11/16/2023 02:16 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:MARIN DAY SCHOOL-OUR PLACE, SMC EMP (PRESCHOOL)FACILITY NUMBER:
414001649
ADMINISTRATOR:SILVA JENNIFERFACILITY TYPE:
850
ADDRESS:403 WINSLOW STREETTELEPHONE:
(650) 363-4939
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 21DATE:
11/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Nicole BakerTIME COMPLETED:
02:35 PM
NARRATIVE
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On November 16, 2023, Licensing Program Analyst (LPA) Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with director, Nicole Baker. LPA explained the purpose of the visit and was given a tour of the facility.
Present in facility are 21 children, with 6 staff members, including the director.

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 January 10, 2023. 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 signs indicating that the water fountain/kitchen fixture is not for drinking and or currently out of order. The affected fixtures are J (5.6) and P (7.6). The location of the fixture J is in preschool classroom and P is in 2 year olds, which is currently not used due to low enrollment. LPA observed that the classroom where fixture P is not being utilized at the moment. The facility changed the affected fixtures in January and flushed. The facility then retested the fixtures on March 2, 2023. The retest results show fixtures J and P are now below the 5.4ppb threshold at J (1.9), J30 (ND), and P (3.3) P30 (1.6) parts per billion (ppb). The facility were using other water sources for food preparation, and water ingestion during remediation.

LPA obtained emailed copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999).

* See next page for deficiencies cited today and will also be cleared on the same day.

This report was reviewed and signed by Director, Nicole Baker.

This notice of Site visit was provided to the Director and must remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/16/2023 02:16 PM - It Cannot Be Edited


Created By: Nathan Garcia On 11/16/2023 at 02:06 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: MARIN DAY SCHOOL-OUR PLACE, SMC EMP (PRESCHOOL)
FACILITY NUMBER: 414001649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
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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The facility had the fixtures replaced, flushed and retested on March 2, 2023. The retest results show below 5 ppb of lead for fixtures J and P. Facility had remediated the affected fixtures before the visit.
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Based on results received from the certified water samplers, the facility exceeded 5.4 ppb of lead in their water source. This posed a potential health, safety, or personal rights risk to persons in care.
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Deficiency will be cited and cleared on the same visit, 11/16/2023.

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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


LIC809 (FAS) - (06/04)
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