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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005616
Report Date: 07/03/2024
Date Signed: 07/03/2024 01:12:37 PM

Document Has Been Signed on 07/03/2024 01:12 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NEW VILLAGE SCHOOL, THEFACILITY NUMBER:
214005616
ADMINISTRATOR/
DIRECTOR:		ROBIN BARNEBYFACILITY TYPE:
850
ADDRESS:100 EBBTIDE AVENUE, ROOM 350TELEPHONE:
(415) 289-0889
CITY:SAUSALITOSTATE: CAZIP CODE:
94965
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 8DATE:
07/03/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:03 PM
MET WITH:Robin BarnebyTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On July 3, 2024 Licensing Program Analyst (LPA) arrived at the facility for an unannounced case management visit for lead testing/exceedance. LPA met with director, Robin Barneby. LPA explained the purpose of the visit.
Present in facility are 8 children supervised by the director and two teenage volunteers for their summer program.

Today's visit is in reference to the annual visit that occurred on 1/26/2024 where the facility was cited for not completing the lead water testing within the 180 days of licensure. The facility completed the lead water testing on 2/15/2024, prior to the Plan of Correction (POC) deadline of 2/26/2024. The facility lead water testing results reveal no lead exceedances. All LIC forms associated with the lead water testing have been submitted to the department/LPA. The deficiency cited on the annual visit on 1/26/2024 was unable to be cleared due to a technical issue. Therefore, the deficiency will be recited and cleared during today's visit.

LPA observed the indoor and outdoor areas are free from health and safety hazards. The outdoor area has play structures, multiple covered sandbox, and a shaded areas for the children to rest. There are a variety of toys available for the children such as mud kitchen. There are also sheds/bins and storage areas for the toys when they're not being used. LPA observed a climbing structure outside.

A copy of this report, and the “Notice of Site Visit” were given to the Director. 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 by director, Robin Barneby.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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 07/03/2024 01:12 PM - It Cannot Be Edited


Created By: Nathan Garcia On 07/03/2024 at 12:57 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: NEW VILLAGE SCHOOL, THE
FACILITY NUMBER: 214005616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2024
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, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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The deficiency cited today is in reference to the annual visit from 1/26/2024 that was unable to be cleared due to a techncal issue. The facility completed the lead water testing prior to the original deadline with no lead exceedances.

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Based on (interview) (record review)], the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
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Deficiency cited today will be cleared during today's visit.

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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:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


LIC809 (FAS) - (06/04)
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