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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004222
Report Date: 02/29/2024
Date Signed: 02/29/2024 01:15:07 PM

Document Has Been Signed on 02/29/2024 01:15 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:DANIEL WEBSTER ELEMENTARYFACILITY NUMBER:
414004222
ADMINISTRATOR:BUGANTE, KARENFACILITY TYPE:
850
ADDRESS:425 EL DORADOTELEPHONE:
(650) 991-1000
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 24TOTAL ENROLLED CHILDREN: 19CENSUS: 17DATE:
02/29/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Karen BuganteTIME COMPLETED:
01:30 PM
NARRATIVE
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On February 29, 2024 at approximately 12:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management inspection in regards to lead testing for child care centers. LPA met with site supervisor, Karen Bugante, and explained the purpose of the inspection. Present during visit included 17 children and 2 teacher assistants.

Children have access to drinking water at facility with an accessible water pitcher and cups. The water pitcher is refilled at the facility through a water fixture located in the classroom.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

As of this date, facility is not completed lead water testing that is is in accordance to 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.

Facility is being cited a Type B citation for not completing lead water testing requirement prior to due date. A plan of correction was discussed and appeal rights were provided.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the site supervisor, Karen Bugante.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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 02/29/2024 01:15 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 02/29/2024 at 12:54 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: DANIEL WEBSTER ELEMENTARY
FACILITY NUMBER: 414004222

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
HSC
1597.16(a)(1)

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HSC 1597.16(a)(1) A licensed child day care center... 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...

This requirement is not met as evidenced by:
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Facility to test their water fixtures used for drinking and food preparation no later than POC due date.
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Based on interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
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LPA reminded site supervisor facility must be completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA reminded site supervisor lead testing must be completed by an ELAP certified laboratory.

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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:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
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