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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800967
Report Date: 10/14/2022
Date Signed: 10/17/2022 02:09:58 PM

Document Has Been Signed on 10/17/2022 02:09 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:CITY TREE CHRISTIAN SCHOOLFACILITY NUMBER:
370800967
ADMINISTRATOR:LISA PHIPPSFACILITY TYPE:
850
ADDRESS:320 DATE STREETTELEPHONE:
(619) 232-3794
CITY:SAN DIEGOSTATE: CAZIP CODE:
92101
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 38DATE:
10/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Lisa PhippsTIME COMPLETED:
10:50 AM
NARRATIVE
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On 10/14/2022 at approximately 09:35 AM, Licensing Program Analyst (LPA) Edgar Campana conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of lead detected in facility water fixtures. LPA met with facility director, Lisa Phipps. The purpose of the inspection was explained, and facility was toured. Present in facility were 38 children with 9 staff.

LPA 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 CCCs 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), on 07/06/2022.

On 07/12/2022 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 05/28/2022. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels were as follows:

A – Sink Faucet, Room 104, room is currently in use. Faucet removed from service.
E – Sink Faucet, Room 100, room is currently in use. Faucet removed from service.
F – Sink Faucet, Room 100, room is currently in use. Faucet removed from service.
T – Sink Faucet, Room 307, room located on campus, but not part of facility.
U – Sink Faucet, Room 306, room located on campus, but not part of facility.
V – Drinking Fountain, Rooftop play yard. Fountain removed from service.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CITY TREE CHRISTIAN SCHOOL
FACILITY NUMBER: 370800967
VISIT DATE: 10/14/2022
NARRATIVE
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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.

Facility director stated that all fixtures/outlets which reported with 5.5 ppb or greater lead exceedance levels have been replaced. Director further stated that facility has applied for grant funding (per PIN 21-04-CCP) and that retesting of fixtures/outlets is pending approval by the Sacramento State, Office of Water Programs (OWP).

LPA informed facility representative, Lisa Phipps, that this report dated 10/14/2022 documents one (1) Type B citation.

LPA advised director that parents must be notified of the lead exceedances. Licensees shall post testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility within 24 hours of receiving the results from the Department.

Exit interview conducted and report was reviewed with facility director, Lisa Phipss. A copy of this report, along with Appeal Rights (LIC9058 03/22), 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
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Document Has Been Signed on 09/14/2023 02:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/28/2023 12:22 PM


Created By: Edgar Campana On 10/13/2022 at 01:57 PM
Link to Parent Document Below:
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: CITY TREE CHRISTIAN SCHOOL
FACILITY NUMBER: 370800967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/14/2022
Section Cited

101700.3(b)(1)

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*This is an amended version of report created on 10/14/2022* 101700.3 California Lead Action Level at Child Care Centers. (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) 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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The facility has made all outlets that tested with an ALE out of service and posted appropriate signage. Facility director stated they have replaced the impacted outlets. Fixtures are to be retested by a certified water sampler and a follow-up water sample must be taken following the protocol outlined in Written Directives, Section 101705. Facility director stated that children in care will be provided with alternative potable water, by using alternate outlet/bottled water/water cooler, while waiting to replace the outlet.
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Based on record review, the facility is in violation of the directive above, as 1 outlet used for drinking and/or food preparation, and five outlets which are not used for drinking and/or food preparation, tested with an Action Level Exceedance (ALE). This poses a possible Health and Safety risk to children in care.
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 Facility director stated that parents will be notified of the lead exceedances via email.
Facility director stated that water sample results will be provided to the San Diego Regional Office no later than 11/14/2022. (within 30 days)

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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:Jason Garay
LICENSING EVALUATOR NAME:Edgar Campana
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


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