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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000465
Report Date: 10/14/2022
Date Signed: 10/15/2022 12:07:31 PM


Document Has Been Signed on 10/15/2022 12:07 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:POINT LOMA COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
372000465
ADMINISTRATOR:NICOLE HAGEFACILITY TYPE:
850
ADDRESS:2128 CHATSWORTH BOULEVARDTELEPHONE:
(619) 223-3327
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY:120CENSUS: 71DATE:
10/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nicole HageTIME COMPLETED:
01:40 PM
NARRATIVE
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On 10/14/22 at 12:00pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced case management inspection for the Action Level Exceedance (ALE) of lead detected in facility water fixture. LPA met with facility representative, Nicole Hage. The purpose of the inspection was explained and facility was toured. Present in facility were 71 children 16 staff members.

LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs 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.

LPA obtained copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276) Facility Sketch (LIC999) on 7/7/22.

On 8/30/22 the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 7/20/22. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels were as follows:

B – Drinking fountain in hallway next to office, currently not in use

Facility no longer utilizes the drinking fountain located in the hallway. Facility turned off the water and placed a ‘do not use’ sign on the drinking fountain. Facility provides water for children via a water cooler. Facility representative stated the drinking fountain will be removed and proof submitted to CCL.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.
See LIC809C continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: POINT LOMA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 372000465
VISIT DATE: 10/14/2022
NARRATIVE
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LPA informed facility representative, Nicole Hage that this report dated 10/14/22 documents one (1) Type A citation on the LIC809-D which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed facility representative to provide a copy of this licensing report dated 10/14/22 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with facility representative, Nicole Hage. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2022 12:07 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: POINT LOMA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 372000465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited

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101700.3 California Lead Action Level at Child Care Centers. (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.
This requirement is not met as evidenced by:
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Based on record review, the licensee did not comply with the directive above, as one (1) outlet used for drinking and/or food preparation tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to children in care.
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Facility representative stated that children in care will be provided with alternative potable water, by using alternate outlet water cooler. Facility representative stated that parents will be notified of the lead exceedances via email. Facility representative stated the POC will be provided to the San Diego Regional Office no later than 11/14/22.

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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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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