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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370500
Report Date: 11/02/2022
Date Signed: 11/02/2022 01:58:47 PM


Document Has Been Signed on 11/02/2022 01:58 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:FIRST CHRISTIAN PIERSIDE PRESCHOOLFACILITY NUMBER:
304370500
ADMINISTRATOR:MCCLELLAN, JENNIFER M.FACILITY TYPE:
850
ADDRESS:1209 MAIN STREETTELEPHONE:
(714) 536-4111
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:110CENSUS: 60DATE:
11/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Director Jennifer McClellan and Bonnie Worthen TIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Romy Castanon conducted an unannounced Case Management visit. LPA met with Director Jennifer McClellan and Family Life Pastor (FLP) Bonnie Worthen to discuss the Lead Sampling Testing conducted on 9/27/22. Director was advised on 11/01/22 that the Lead Sample Report was to be posted. Director will provide LPA with all documentation requested regarding Lead; Facility sketch, LIC 9275 and LIC 9276 by 11/07/22 . LPA confirmed that FLP Bonnie had posted the Lead Sample Report during visit on 11/02/22.

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 09/2722 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.


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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FIRST CHRISTIAN PIERSIDE PRESCHOOL
FACILITY NUMBER: 304370500
VISIT DATE: 11/02/2022
NARRATIVE
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LPA observed outlet A in Room 114 was made inoperable via white trash bag. Outlet K is located in Room 114. Both outlet's main waterline was shut off. LPA instructed FLP Bonnie to cover outlet K. During visit, LPA confirmed that outlet was covered with a white trash bag and blue tape. Facility provides water for children in pitchers from outlets that were not deemed an action level exceedance. Children are also allowed to bring their own water bottles.

Based on LPA's observation and interview with Director and FLP, the following violation was observed and is being cited in accordance with Written Directives Section 101700.3 (b)(1) California Lead Action Level at Child Care Centers, is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with Director Jennifer McClellan and Family Life Pastor Bonnie Worthen. 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.

(End of Report)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/02/2022 01:58 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: FIRST CHRISTIAN PIERSIDE PRESCHOOL
FACILITY NUMBER: 304370500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2022
Section Cited

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101700.3 (b) Testing results with fractional ppb readings of 0.5 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.
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This requirement is not met evidenced by record review of the lab report analysis from Outlet A and K taken on 09/27/22. Results indicated levels of lead in exceedance. This poses a potential risk to the health and safety of children 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: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M CastanonTELEPHONE: (714) 746-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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