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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518279
Report Date: 02/27/2025
Date Signed: 02/27/2025 10:37:09 AM

Document Has Been Signed on 02/27/2025 10:37 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:WEST HILLSBOROUGH PRESCHOOLFACILITY NUMBER:
410518279
ADMINISTRATOR/
DIRECTOR:		LINDNER, MATTHEWFACILITY TYPE:
850
ADDRESS:376 BARBARA WAY, RM. 12TELEPHONE:
(650) 344-9870
CITY:HILLSBOROUGHSTATE: CAZIP CODE:
94010
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: DATE:
02/27/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:School Principal, Heather MataTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
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On 02/27/2025, at approximately 9:00AM, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced case management visit regarding an Action Level Exceedance (ALE) due to lead in the Child Care Center's water. LPA was granted entry to the facility by the school principal, Heather Mata. LPA explained the purpose of the visit. Present during the visit were 3 staff and 9 children. The facility is in compliance with staff-child ratios.

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 Principal 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 initially tested its water for lead on 12/20/2024 and was not in compliance with the testing requirement.

The facility received the initial ALE report from the Vendor on 02/12/2025. Test results for three fixtures in this facility exceeded a higher level of parts per billion (ppb), allowed, 5.5 ppb, fixtures A(9.3), fixture B(12.0), and fixture C(7.4). Fixture A is a sink located in the classroom's sink, drinking fountain, Fixture B and C are locates outside, in a sink, the faucet, and drinking fountain. LPA observed water sources A, B, and C to be blocked off and inaccessible to children in care. Per director, Tony Giacomazzi, the facility plans to fix the pipes and retest for lead water once, piping has been complete. Per teacher, the facility provided an alternative water source, using a brittle water filter to serve children water. All other fixtures tested below the threshold and are in compliance with the Written Directives detailed in PIN 21-21.1-CCP.

Per Written Directives 101700.3(b)(2), licensees shall maintain a lead value at or below 5ppb in all outlets subject to testing requirements for the health and safety of children in care. Due to updated guidance on the written directives in PIN 21-21.1-CCP, the facility will be cited for the ALE of fixtures A, B, and C.

Please see LIC809-D for deficiency cited and cleared today.

This report was reviewed and signed by the Principal, Heather Mata.

A Notice of Site Visit was given and must be posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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 02/27/2025 10:37 AM - It Cannot Be Edited


Created By: Melissa Zaragoza On 02/27/2025 at 10:17 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: WEST HILLSBOROUGH PRESCHOOL
FACILITY NUMBER: 410518279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2025
Section Cited

101700.3

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101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by:
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The facility plans to change the piping, and once piping is complete, they will retest. Director will submit a date for retest and update the LPA for the retest results, once available.
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Based on results received from the certified water samplers, the facility exceeded 5.5 ppb of lead in their water source. This pose a potential health, safety, or personal rights risk to persons in care.
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Type B
03/27/2025
Section Cited
HSC1597.16(a)(1)

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HSC 159.16(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.

This requirement is not met as evidenced by:
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Facility tested water fixtures on December 20, 2024, after the lead testing requirement due date. Deficiency cleared during visit.
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Based on observation and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons 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:Marie Rodriguez
LICENSING EVALUATOR NAME:Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2025


LIC809 (FAS) - (06/04)
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