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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004670
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:46:13 PM

Document Has Been Signed on 02/02/2023 02:46 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PALCARE (TIDEPOOLS)FACILITY NUMBER:
414004670
ADMINISTRATOR:KIESSELBACH, LISAFACILITY TYPE:
830
ADDRESS:1001 CALIFORNIA DRIVETELEPHONE:
(650) 787-5477
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 11DATE:
02/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Tina HardleyTIME COMPLETED:
03:00 PM
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On 2/2/23 at approximately 1:50PM, Licensing Program Analysts (LPAs) Nathan Garcia conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the Site Director, Tina Hardley. The purpose of the inspection was explained.

Present in facility are 11 infant children, present with 4 staff members during nap time.

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 12/22/2022. 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. Per director, the fixture was replaced on 1/5/23 and was flushed and got retested on 1/25/23. They are currently waiting for the retest results. The infant center uses a filtered water source that passed for ingestion and the affected fixture is a sink located in the staff lounge.

LPA obtained the copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), in an email to the LPA. LPA obtained copy of the lead water testing results as well.

No deficiencies cited today.

Considering that the children have no access to the fixture due to the children having formulas and milk brought from home. Also, that the fixture was already retested at the time of visit. Director will still need to send retest results to the department once received from the certified water samplers.

This report was emailed to Director Tina Hardley and Lisa Kiesselbach due to printer malfunction. Confirmation of receipt will be required.

This report and notice of Site visit is provided to the licensee and must remain posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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