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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600097
Report Date: 09/23/2022
Date Signed: 12/08/2022 10:52:43 AM


Document Has Been Signed on 12/08/2022 10:52 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:LA PETITE ACADEMY - SCHOOL-AGE DAY CARE CENTERFACILITY NUMBER:
376600097
ADMINISTRATOR:GLADYS GARCIAFACILITY TYPE:
840
ADDRESS:798 EAST J STREETTELEPHONE:
(619) 421-0966
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:30CENSUS: 0DATE:
09/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Angelica ValdarramaTIME COMPLETED:
03:00 PM
NARRATIVE
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On 9/23/22 at 3:00 pm, LPA Adrian Castellon made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Assistant Director Angelica Valdarrama. LPA interviewed assistant director and examined the faucets deemed an Action Level Exceedance.

Faucets and spigot reported with 5.5 ppb or greater lead exceedance levels were as follows:
School Age Classroom Faucet A (staff use only) 21.1 ppb
School Age Classroom Faucet C (staff use only) 5.57 ppb


Assistant Director stated faucets have not been used by staff since testing results have been received. Assistant Director states that faucets in exceedance are flushed four times daily and will be retested on 10/6 and 10/7. Children have been advised to bring water bottles to school each day and the facility uses a jug with a filter to provide refills. Extra bottles are available to children that forget their water bottles. Kitchen sink faucet used for food preparation was not in exceedance. All staff have been informed not to use the faucets in exceedance for drinking water or food preparation.

See LIC809D for Type B deficiency cited.

Exit interview conducted. Appeal rights were discussed and given to assistant director on this date. Notice of Site Visit was given to assistant director.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
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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Document Has Been Signed on 12/08/2022 10:52 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: LA PETITE ACADEMY - SCHOOL-AGE DAY CARE CENTER
FACILITY NUMBER: 376600097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2022
Section Cited

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101700.3(b)(1) Written Directives: 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 water testing results and interview, facility tested over the Action Level Exceedance level at two water sources (faucets). This may pose a health, safety or personal rights risk to 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2