300601002-4-11-2024-06-CC-AFCN-D48V4J-20240411160624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300601002
Report Date: 04/11/2024
Date Signed: 04/11/2024 04:06:31 PM

Document Has Been Signed on 04/11/2024 04:06 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	YORBA LINDA UNITED METHODIST CHURCH PRESCHOOL		FACILITY NUMBER:	300601002
ADMINISTRATOR:	WELSH, JOANNA		FACILITY TYPE:	850
ADDRESS:	19002 YORBA LINDA BLVD.		TELEPHONE:	(714) 777-2384
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	82	CENSUS: 15	DATE:	04/11/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Director Ana Macias		TIME COMPLETED:	04:20 PM

NARRATIVE

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On 4/11/24, at 2:50pm Licensing Program Analyst (LPA) Anna Chan conducted an unannounced Case Management visit. LPA met with Assistant Director, Elisa Spitler. LPA explained the reason for visit to discuss the Lead Sampling Testing. LPA walked through of the facility without facility staff since the assistant director is in classroom #1 with 5 children, the rest of the children where in the playground across classroom #1, LPA observed 10 children and 2 staff. Director Ana Macias arrived around 3:25pm to continue with the visit.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE). The facility stated they replaced the faucet with lead exceedance and was cited.

Instructions for required lead testing are outlined in PIN 21-21-CCP. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

Child Care Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in parts per billion (ppb) unit of measurement.

Director was advised that on 04/01/23, lead testing was done in the facility and the water on Outlet A failed with a result of 22ppb. Facility stated the facucet was replaced but documents are not available. Director stated that the facility provides Arrowhead bottled water. Director stated the facility will find out when the faucet was replaced and when re-testing was done.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YORBA LINDA UNITED METHODIST CHURCH PRESCHOOL	FACILITY NUMBER: 300601002
	VISIT DATE: 04/11/2024

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Based on LPA's record review and interview with Director Ana Macias, the following violation was observed and is being cited in accordance with Title 22 California Code of Regulations Section 101700.3(b) Wtitten Directives

Exit interview conducted and report was reviewed with Director Ana Macias. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights and deficiency were explained. The Director was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2024 04:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YORBA LINDA UNITED METHODIST CHURCH PRESCHOOL	FACILITY NUMBER: 300601002
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/13/2024 Section Cited 101700.3(b)	1 2 3 4 5 6 7	101700.3 California Lead Action Level at Child Care Centers (b) Testing results...comparing to the Action Level. (1) A result with values of 5.5 part per billion or greater shall be deemed an Action Level Exceedance.	1 2 3 4 5 6 7	Director stated that facility followed Written Directives and submitted all required documentation including LIC 9275, 9276, plan of correction and details of steps taken to resolve the deficiency by due date. Or do a re-test for Faucet A that failed test
	8 9 10 11 12 13 14	This requirement was not met evidenced by: Lab report analysis water from Outlet A (22 parts per billion) taken on 04/12023 indicated levels of lead in exceedance. This poses a potential risk to the health, safety and personal rights of children in care.	8 9 10 11 12 13 14	Director stated she will provide the result for the lead re- test on the faucet replacement to LPA by due date of 5/13/24
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC809 (FAS) - (06/04)

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