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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372002147
Report Date: 09/23/2022
Date Signed: 09/23/2022 02:28:19 PM


Document Has Been Signed on 09/23/2022 02:28 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:MONTESSORI SCHOOL HOUSEFACILITY NUMBER:
372002147
ADMINISTRATOR:DENA STONEMANFACILITY TYPE:
850
ADDRESS:4544 POCAHONTAS AVENUETELEPHONE:
(858) 270-9350
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:77CENSUS: 38DATE:
09/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Dena StonemanTIME COMPLETED:
02:45 PM
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On 9/23/22 at 2:00 PM, Licensing Program Analyst (LPA) Adrian Mangina made an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Director, Dena Stoneman. Also present in the facility were 38 daycare children and (6) teachers with (1) assistant teacher in 3 classrooms. Facility was within ratio & capacity. LPA interviewed staff and examined the drinking fountain deemed an Action Level Exceedance. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on 9/19/22.

Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows:

Drinking Fountain “G” in the school aged portion of the building: 5.7 ppb

Director reported that the faucet in exceedance is not accessed by the preschool as it is located outside the licensed portion of the building in a hallway serving school-aged children. The Preschool shares a building with a school, where the affected drinking fountain is located. LPA verified that the water outlet is in an area that is not accessible to preschool children. Director stated that the water authority recommended that all water outlets in the building be tested, even those that are not associated with the licensed preschool. Director stated that the drinking fountain spout will be replaced as soon as possible and Director will ensure that it is flushed them 4 times a day for 3 weeks and then it will be tested again. Prior to replacement, the fountain was blocked from usage by use of painter’s tape to prevent access and water was turned off at the source. Preschool children will continue to refill water bottles using the filtered water machine located in the preschool kitchen in the licensed area of the building. All staff have been informed not to use the affected outlet for drinking water or food preparation.

See LIC9102 for technical violation given.

Exit interview conducted and report was reviewed with the facility representative, Dena Stoneman. A copy of PIN 21-21-CCP was provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022
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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