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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002868
Report Date: 11/15/2023
Date Signed: 11/15/2023 02:19:46 PM

Document Has Been Signed on 11/15/2023 02:19 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:SISTER CLAIRE'S PRESCHOOLFACILITY NUMBER:
414002868
ADMINISTRATOR:MARIA JULIE PICARDALFACILITY TYPE:
850
ADDRESS:7 ELMWOOD DRIVETELEPHONE:
(650) 756-4916
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 33DATE:
11/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Julie PicardalTIME COMPLETED:
02:35 PM
NARRATIVE
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On 11/15/2023, at approximately 1:30PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) due to lead in the Child Care Center's water. LPA was granted entry to the facility by Director, Julie Picardal. LPA explained the purpose of the visit. Present during the visit were six staff and 33 children. The facility is in compliance with staff-child ratios.

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 initially tested its water for lead on 12/22/2022 and was in compliance with the testing requirement.

The facility received its initial ALE report from the Vendor on 2/3/2023. Test results for four fixtures in this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb, fixtures A(26.0), B(13.0), F(5.7), and H(36.0). Fixtures A and H are water fountains located outside the classrooms. Fixture B is a staff hand washing sink located in the bathroom of the Wise Owls B classroom. Fixture F is a kitchen sink in the staff lunch room that is used for food preparation. The facility ceased use of all affected fixtures until the fixtures received lead filters and used water from unaffected fixtures. The facility retested the four fixtures on 5/13/2023 and all affected fixtures are now under the ALE of 5.5ppb. The parts per billion are as follows: A(<1.0), B(<1.0), F(<1.0), and H(2.7). All other fixtures tested below the threshold and are in compliance with the Written Directives detailed in PIN 21-21.1-CCP.

Per Written Directives 101700.3(b)(2), licensees shall maintain a lead value at or below 5ppb in all outlets subject to testing requirements for the health and safety of children in care. The Written Directives are included in HSC 1597.16, and are specific guidelines for facilities to adhere to regarding lead water testing. Due to updated guidance on the written directives in PIN 21-21.1-CCP, the facility will be cited for the ALE of fixtures A, B, F, and H. The deficiency will be cleared the same day of the visit because the fixtures have retested below the threshold. LPA advised that lead testing results and LIC forms 9275, 9276 and 999 should be posted.

This report was reviewed and signed by Director, Julie Picardal.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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 11/15/2023 02:19 PM - It Cannot Be Edited


Created By: Jonathan Tse On 11/15/2023 at 02:04 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: SISTER CLAIRE'S PRESCHOOL
FACILITY NUMBER: 414002868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
HSC
1597.16

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WD101700.3(b)(2) Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.

This requirement was not met as evidenced by:
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The facility took steps to remediate the fixtures by immediately marking them as unavailable for use by children and staff. The facility also maintained consistent communication with the Regional Office for guidance on how to proceed once testing was completed. The fixtures were remediated by adding lead filters to them.
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Based upon record review, the facility had ALEs above 5ppb in four fixtures: A, B, F and H. This posed a potential threat to the health, safety, or personal rights to persons in care.
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This deficiency will be cited and cleared the same day of the visit, 11/15/2023.

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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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023


LIC809 (FAS) - (06/04)
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