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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700300
Report Date: 04/21/2023
Date Signed: 04/21/2023 12:51:27 PM


Document Has Been Signed on 04/21/2023 12:51 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:ADOBE BLUFFS PRESCHOOLFACILITY NUMBER:
376700300
ADMINISTRATOR:DAISY CAIFACILITY TYPE:
850
ADDRESS:8707 ADOBE BLUFFS DRIVETELEPHONE:
(858) 748-0010
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:22CENSUS: DATE:
04/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Daisy CaiTIME COMPLETED:
01:00 PM
NARRATIVE
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On 4/21/23 at 12:16pm, LPA Annette Sutherland made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with staff member Daisy Cai. Also present in the facility were 18 daycare children and 3 teachers/staff in 1 room. Facility was within ratio & capacity. LPA interviewed Ms. Daisy and examined the faucet deemed an Action Level Exceedance.

Faucet reported with 5.5 ppb or greater lead exceedance levels was as follow:

Drinking fountain on black top         6.600 ppb

Faucet in exceedance is a drinking fountain is not currently being used for drinking. Drinking fountains on black top are covered with bags, making them inaccessible to children. Children bring water bottles to school each day and the facility provides bottled water to refill the bottles. 

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Daisy Cai. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
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 04/21/2023 12:51 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: ADOBE BLUFFS PRESCHOOL
FACILITY NUMBER: 376700300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
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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Corrections were made prior to testing. Drinking faucets have not been used prior tocovid. Bags are wrapped around drinking faucets. Children bring their own water bottles to school , facility will provide additional water with filtered water bottles if needed.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance at one drinking fountain that has not beein used for dinking prior to covid. This poses an potential 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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