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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005482
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:26:44 AM

Document Has Been Signed on 02/29/2024 11:26 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:ACQUA MONTESSORI SCHOOLFACILITY NUMBER:
214005482
ADMINISTRATOR:NICOLAS RYAN MENDOZAFACILITY TYPE:
850
ADDRESS:8 N SAN PEDRO RDTELEPHONE:
(415) 755-7075
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
02/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Nico MendozaTIME COMPLETED:
11:35 AM
NARRATIVE
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On 2/29/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced case management visit to the child care center listed above. The purpose of the visit was to determine whether the lead water testing had been completed. During today’s visit, the LPA met the Director, Nico Mendoza. The director was informed of the reason for today's visit by the LPA. During today's visit, two toddlers and sixteen preschool-aged children were present in the center. Present in the center with fingerprint clearance included the director and two staff members. The center is operating within its capacity and in accordance with the required ratio of staff to children.

During today’s interview with the director regarding lead water testing, it was discovered that the center had not yet completed the lead water testing. The LPA observed the director applying for a grant from the State of California website to address the issue.

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.

LPA verified that the lead testing was not completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

CCC did not complete testing prior to the deadline of 1/1/2023.

LPA referred the director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Please refer to LIC 809D for today’s citation.

A copy of today’s report and the center’s appeal rights were given to Nico Mendoza. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Nico Mendoza.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
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 11:26 AM - It Cannot Be Edited


Created By: Hanson Leong On 02/29/2024 at 10:47 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: ACQUA MONTESSORI SCHOOL
FACILITY NUMBER: 214005482

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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(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,


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The lead water results and supporting documents, such as LIC 999, LIC 9275, and LIC 9276, must be submitted to the department by the above-due date.
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2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Based on the interview with the director, the licensee did not comply with the section cited above, which poses a potential risk to the health, safety, or personal rights of children in care.


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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Hanson Leong
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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