304370212-12-12-2022-06-CC-DTHN-CM2REF-20221212115727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370212
Report Date: 12/12/2022
Date Signed: 12/12/2022 11:57:34 AM

Document Has Been Signed on 12/12/2022 11:57 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	FULBRIGHT MONTESSORI ACADEMY		FACILITY NUMBER:	304370212
ADMINISTRATOR:	BERGMAN, JULIE		FACILITY TYPE:	850
ADDRESS:	20411 JAMES BAY CIRCLE		TELEPHONE:	(949) 583-9292
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	110	CENSUS: 88	DATE:	12/12/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Julie Bergman		TIME COMPLETED:	12:15 PM

NARRATIVE

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Licensing Program Analyst (LPA’s), Thompson and Lucero conducted an unannounced Case Management visit for the purpose to discuss the Lead Sampling Testing conducted on 11/4/2022. LPA met with Director, Julie Bergman, who was explained the reason for today’s visit. LPA observed 88 children in care at the time of 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.

Community Care Licensing was notified that lead water testing conducted at the facility on 11/04/2022 failed allowable limit for lead. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE).

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.

Facility staff was advised on 12/7/2022 that the Lead Sample Report was to be posted. LPA observed the facility had posted the Lead Sample Report.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FULBRIGHT MONTESSORI ACADEMY	FACILITY NUMBER: 304370212
	VISIT DATE: 12/12/2022

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On 12/7/22 LPA receive an email from Director Julie Bergman who provided pictures showing Site ID's A,C,E, and F with a sign that reads "Do Not Use." The outlets that had an ALE over 5.0 had been made inaccessible.

Site ID A, C, E and F had faucets replaced and a 3-week follow up lead testing appointment is scheduled for 12/14/2022. Currently the facility is using Brita water pitchers until remediation.

Based on LPA interview with Director, review of facility sketch and walk-through, the following violation was observed and is being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 3, Section 101700.3 California Lead Action Level at Child Care Centers is being cited on the attached LIC 809D.

Exit interview conducted with Director Julie Bergman. The report was reviewed and discussed. Appeal Rights were discussed. Director was provided copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received the Regional Office within 15 business days.

Director was informed that the "Notice of Site Visit" must be posted for 30 consecutive days. The Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2022 11:57 AM - 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FULBRIGHT MONTESSORI ACADEMY	FACILITY NUMBER: 304370212
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/10/2023 Section Cited	1 2 3 4 5 6 7	101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 5.0 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.	1 2 3 4 5 6 7	Director agreed to submit follow up lead testing results to LPA by POC due date.
	8 9 10 11 12 13 14	Based on lab report analysis water from outlets A (6.02 parts per billion), C (6.64 parts per billion), E (6.26 parts per billion) and F (7.99 parts per billion) taken on 11/4/2022 indicated levels of lead in exceedance.	8 9 10 11 12 13 14
	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: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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