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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110822
Report Date: 03/29/2023
Date Signed: 03/29/2023 08:59:20 AM

Document Has Been Signed on 03/29/2023 08:59 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ICE CREAM & SHOE PRESCHOOL & KINDERGARTEN INC.FACILITY NUMBER:
210110822
ADMINISTRATOR:RACZKA, SUSANFACILITY TYPE:
850
ADDRESS:1055 LAS OVEJASTELEPHONE:
(415) 492-0550
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 0DATE:
03/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Virginia JacksonTIME COMPLETED:
09:14 AM
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On 3/29/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced Plan of Correction visit to the Ice Cream & Shoe Preschool & Kindergarten facility. This is a follow up-visit to ensure the previous Type B violation was corrected, which occurred on 2/24/2023. The LPA was granted entry by Virginia Jackson. The LPA explained the purpose of the visit to Ms. Jackson. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. During the visit, there was no children present in the facility

During the department's last visit on 2/24/2023, the facility was issued the following Type B violation:

1. Health and Safety Code 1597.16(a)(1)- 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.



During today's visit, Ms. Jackson presented documents pertaining to the LEAD water testing to the LPA. After reviewing the documents pertaining to the LEAD water testing, the facility was able to demonstrate to the department that the initial process of the LEAD water testing had begun. Because the facility has begun the LEAD water testing process, the department will extend her Plan of Correction date from 3/24/2023.

A copy of this report, and the “Notice of Site Visit,” were given to Virginia Jackson.

A “Notice of Site Visit” must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Virginia Jackson.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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