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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701152
Report Date: 05/24/2023
Date Signed: 05/24/2023 11:06:26 AM


Document Has Been Signed on 05/24/2023 11:06 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:APPLE YOUCHIENFACILITY NUMBER:
376701152
ADMINISTRATOR:YUKIKO ONOFACILITY TYPE:
850
ADDRESS:2550 FAIRFIELD STREETTELEPHONE:
(619) 994-0620
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:30CENSUS: 24DATE:
05/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Yukiko OnoTIME COMPLETED:
11:10 AM
NARRATIVE
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On 05/24/23 at 10:05am, Licensing Program Analysts (LPAs), Selina Siao and Gerald Poindexter conducted an unannounced case management inspection for the Action Level Exceedance (ALE) of lead detected in facility water fixture. Upon arrival, LPAs conducted a tour of the two classrooms and observed the following ratios: Room 1 had 10 kids supervised by teacher Masami Kelley and teacher aide Junko Sponsler who were gathering the children from the playground. Room 2 had 14 children supervised by teacher Natsuko Lauritzen and Yuri Erickson. All staff members have the required background clearances and are associated to the facility. Director arrived to the facility during the inspection.

LPA Siao 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 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) from Director on 05/11/2023. Facility posted the lead exceedance result at the facility's entrance door and in classroom #2 bulletin board.

On 04/20/23 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 04/14/23. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels was as follow:

Sample Sink Faucet Outlet A – sink water faucet in classroom #2, currently not in use for drinking and food prep.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 05/24/2023 11:06 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: APPLE YOUCHIEN
FACILITY NUMBER: 376701152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2023
Section Cited
CCR
101700.3

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Facility failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for Sample Sink Faucet Outlet A located in classroom 2. Water testing results identified with Action Level Exceedance as defined in WD/Written Directive section 101700.3. are not deemed safe to drink.
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Director stated that they have not been using the faucet sink in classroom #2 since they obtained the lead water exceedence results. Facility will no longer use the sink faucet in room #2 for drinking water or food prep.
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This requirement is not met as evidence by: Based on record review, the licensee did not comply with the directive above, as one faucet sink A in classroom 2 tested with an Action Level Exceedance (ALE). This poses a potential ealth and Safety risk to children in care.
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Facility has been ordering five gallons water bottles for the children to use as drinking water. Children brings their own lunch from home.

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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: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: APPLE YOUCHIEN
FACILITY NUMBER: 376701152
VISIT DATE: 05/24/2023
NARRATIVE
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Director stated that the facility no longer utilizes the sink faucet located in classroom #2. Facility placed a "do not use for drinking and or food" sign on the wall directly above the faucet sink. Facility continues to have children bring their own water bottles from home and facility orders 5 gallon water jug from Arrowhead for children to refill their water bottles.

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 LIC809D for type B citation issue:

Exit interview conducted and report was reviewed with facility representative, Yukiko Ono. 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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