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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518963
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:09:02 PM

Document Has Been Signed on 12/04/2023 04:09 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CSSF REC DET-MONTE VERDE AFTER SCHOOL REC PROGRAMFACILITY NUMBER:
410518963
ADMINISTRATOR:ESPINOZA, ELISIAFACILITY TYPE:
840
ADDRESS:2551 ST. CLOUD DRIVETELEPHONE:
(650) 742-0613
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 200TOTAL ENROLLED CHILDREN: 200CENSUS: 116DATE:
12/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Site Supervisor, Kim MorrisonTIME COMPLETED:
04:20 PM
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On 12/4/2023, at approximately 3:45PM, Licensing Program Analyst (LPA) Jonathan Tse 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 Site Supervisor, Kim Morrison. LPA explained the purpose of the visit. Present during the visit were 15 staff and 116 school-age children. The facility is in compliance with teacher-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 Assistant Director 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 is in compliance with testing requirements.

The facility received the initial ALE report from the Vendor on 12/21/2022. Test results for two fixtures in this facility exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb, fixtures E(9.6ppb) and F(9.3ppb). Both fixtures are sinks located in the school kitchen. The facility does not use the kitchen sinks for food preparation, consumption, or hand washing. The fixtures were replaced and retested on 5/17/2023, and results were uploaded on 5/24/2023 showing that they both tested at 4.1ppb, below the ALE. All other fixtures tested below the threshold and are in compliance with the Written Directives detailed in PIN 21-21.1-CCP.

LPA advised that lead testing results and LIC forms 9275, 9276 and 999 should be posted.

No deficiencies were cited during today's visit. This report was reviewed and signed by Site Director, Kim Morrison.

A Notice of Site Visit was given and must be posted for thirty days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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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