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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004829
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:23:54 AM

Document Has Been Signed on 03/28/2024 10:23 AM - 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:NOTRE DAME PRESCHOOLFACILITY NUMBER:
414004829
ADMINISTRATOR:GIULIANETTI, HAYDETFACILITY TYPE:
850
ADDRESS:1200 NOTRE DAME AVENUETELEPHONE:
(650) 591-2209
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 30TOTAL ENROLLED CHILDREN: 25CENSUS: 23DATE:
03/28/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Haydet GiulianettiTIME COMPLETED:
11:00 AM
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On March 28th 2024 Licensing Program Analyst (LPA) Kassandra Medrano conducted an unannounced, case management inspection regarding lead testing for childcare centers. LPA met with Haydet Giulianetti, Director, and explained the purpose of the inspection. Present during the inspection included 23 children (15 preschool children and 8 TK aged children.) and 4 staff including the director.

Prior to todays inspection, on 7/12/2023, California Rural Water Association (CRWA) tested the facility's faucets for lead. Children have access to drinking water at facility via filtered water from the faucets that have been tested by CRWA. The facility received passing results. 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. LPA advised that lead testing results and LIC forms 9275, 9276 and 999 should be posted.


Facility is being cited a Type B citation for not completing lead water testing requirement prior to due date. 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 Facility representative, Haydet Giulianetti.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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 03/28/2024 10:23 AM - It Cannot Be Edited


Created By: Kassandra Medrano On 03/28/2024 at 10:00 AM
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: NOTRE DAME PRESCHOOL
FACILITY NUMBER: 414004829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2024
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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Director stated that they will post completed 9275,9276, and 999.
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Based on record review facility tested on 7/12/23 and did not test by deadline of 1/1/23. As well as facility did not haave required postings for lead posted for public review.
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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: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024


LIC809 (FAS) - (06/04)
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