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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002756
Report Date: 03/19/2024
Date Signed: 03/19/2024 05:07:28 PM

Document Has Been Signed on 03/19/2024 05:07 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:A+ IMMERSION PRESCHOOLFACILITY NUMBER:
414002756
ADMINISTRATOR:SHARON LAU, PRG.DIR.FACILITY TYPE:
850
ADDRESS:1501 SOUTH B STREETTELEPHONE:
(650) 292-0817
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 26DATE:
03/19/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Sharon Lau, Lai LiawenTIME COMPLETED:
05:15 PM
NARRATIVE
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On 3/19/2024 at 3:05PM, Licensing Program Analyst (LPA) Luis Gomez conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with Staff, Lai Jiawen (Carmen)and explained purpose of the inspection. Present were 5 staff supervising 26 children. Director, Sharon Lau arrived during inspection. LPA inspected facility for health and safety hazards.

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 vendor on 1/26/2024. Test results for this facility show exceedance of higher level of parts per billion (ppb) than allowable, 5.5 ppb on water fixture B.

Per director, the affected fixture, (B) has been used for hand washing only, and is located in left side of the children bathroom. Per director, facility uses sinks in kitchen area for food preparation, water ingestion or water bottle refill.

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

During today’s inspection, deficiency was observed in areas evaluated according to Title 22, Section 12 Chap 1 Ca Code of Regulations and cited on 809D. Exit interview, plan for correction, and evaluation report was discussed with Licensee, Sharon Lau. Director’s signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. The licensees were advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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 03/19/2024 05:07 PM - It Cannot Be Edited


Created By: Luis Gomez On 03/19/2024 at 04:29 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: A+ IMMERSION PRESCHOOL
FACILITY NUMBER: 414002756

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2024
Section Cited
CCR
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 cease immediately the use of affected fixture (fixture B) from childcare operations. Facility will ensure affected fixture replaced and retested prior to the due date: 4/1/2024.
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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 (B). This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.

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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:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024


LIC809 (FAS) - (06/04)
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