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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004095
Report Date: 04/12/2024
Date Signed: 04/12/2024 03:18:26 PM

Document Has Been Signed on 04/12/2024 03:18 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:NATIVITY SCHOOLFACILITY NUMBER:
414004095
ADMINISTRATOR/
DIRECTOR:		VLAD, LAURAFACILITY TYPE:
850
ADDRESS:1250 LAUREL STREETTELEPHONE:
(650) 325-7304
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 39TOTAL ENROLLED CHILDREN: 37CENSUS: 9DATE:
04/12/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Laura VladTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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On April 12,2024 Licensing Program Analyst (LPA) Kassandra Medrano conducted an unannounced, case management inspection regarding lead testing for childcare centers. LPA met with Director, Aerelia "Laura" Vlad, and explained the purpose of the inspection. Present during visit included 9 children and 4 staff. During review of criminal record clearances, it was found that an individual, s1, was present in the facility but not associated. The individual does have criminal record clearance through CPMB.
Children have access to drinking water at facility with an accessible water pitcher and personal water bottles. The water pitcher is refilled at the facility via a filtered water faucet located in classroom sink. Director stated that facility was built after 2010, but was unable to provide documentation of the new builds permits.
LPA discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the facility representative during the inspection. All Child Care Centers that are licensed 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.

As of this date, facility has not completed lead water testing that is in accordance with the Written Directives outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: Toxicity Prevention and Water Testing Information.

LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH APPLICANT/PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

This TYPE A citation page shall be posted for 30 days along with the “Notice of Site Visit.” This page shall be provided to all parents of children currently enrolled, and any future children being enrolled for the next 12 months per AB 633 requirements.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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 04/12/2024 03:18 PM - It Cannot Be Edited


Created By: Kassandra Medrano On 04/12/2024 at 02:50 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: NATIVITY SCHOOL
FACILITY NUMBER: 414004095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/13/2024
Section Cited
HSC
1597.16(a)(1)

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 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 was not met as evidenced by:
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Facility to send proper documentation or test for lead.
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Based on record review it was observed that facility has not completed lead testing. Director stated that building was built in 2015 but no documentation was uploaded to site as well as proper documentation to prove the build.
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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:Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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Document Has Been Signed on 04/12/2024 03:18 PM - It Cannot Be Edited


Created By: Kassandra Medrano On 04/12/2024 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: NATIVITY SCHOOL
FACILITY NUMBER: 414004095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/12/2024
Section Cited
CCR
102370(d)(2)

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d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.
This requirement was not met as evidenced by:
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Director to send in LIC 9182 to RO and ensure that staff is associated before returning to facility.
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Based on record review, it was observed that S1 was present in the facility and not associated to license. Based on interview S1 has been in facility for 2 years.
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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:Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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