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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711284
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:03:29 PM


Document Has Been Signed on 05/10/2023 04:03 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:MONTESSORI CHILDREN'S SCHOOLFACILITY NUMBER:
401711284
ADMINISTRATOR:MARY KERNFACILITY TYPE:
850
ADDRESS:4200 SOUTH HIGUERATELEPHONE:
(805) 544-6691
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:45CENSUS: 36DATE:
05/10/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Mary KernTIME COMPLETED:
04:15 PM
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On 5/10/23, at 2:50 PM Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection at the abovementioned Child Care Center (CCC) to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by Division of Drinking Water (DDW). LPA met with CCC Director, Mary Kern, and advised of the purpose of the inspection. LPA,, in the company of Director, toured the interior and exterior of the CCC. LPA observed 36 children in care at the time of the inspection.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five (5) years after the date of the first test. If the water testing results indicate that the facility has an ALE, an immediate response shall be required pursuant to section 101704, which may include remediation.

The Regional Office received ALE reading for one water outlets in this facility. The CCC was notified of the reading (Preschool bubbler- 6.4 ppb) on 3/24/25. Director informed LPA the water fixtures is in the process of being dismantled and removed. The water fixture was removed from service and is not used by children in care or staff members, Moreover, the fixture was never used for food preparation. LPA notes the fixture is deactivated and not in sorts.

LPAs provided a copy of PUB 515 and discussed the need for the CCC to share this with families.

LPA shared the following resources quick references:

Quick references:
· PIN 22-06-CCP - Lead Testing in Child Care Centers – Frequently Asked Questions
· PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370
· External Water Sampler Self-Certification Form (LIC 9275)
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MONTESSORI CHILDREN'S SCHOOL
FACILITY NUMBER: 401711284
VISIT DATE: 05/10/2023
NARRATIVE
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· Child Care Center Sampling Checklist Form (LIC 9276)
· CDSS Lead Toxicity Prevention and Water Testing Information page
· Resources listed on Sacramento State University, Office of Water Program website
· CCLD website: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information


Should the facility decide to use the outlet in the future for children in care, they must correct the ALE and retest to ensure they are staying in compliance.

No deficiency was cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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