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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370805130
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:55:15 PM

Document Has Been Signed on 12/01/2022 02:55 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:ASSOCIATED STUDENTS CHILD CARE CENTERFACILITY NUMBER:
370805130
ADMINISTRATOR:MICHELLE ZAMORAFACILITY TYPE:
850
ADDRESS:5500 CAMPANILE DRIVETELEPHONE:
(619) 594-7941
CITY:SAN DIEGOSTATE: CAZIP CODE:
92182
CAPACITY: 136TOTAL ENROLLED CHILDREN: 136CENSUS: 79DATE:
12/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Michelle ZamoraTIME COMPLETED:
01:15 PM
NARRATIVE
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Due to computer malfunction at conclusion of visit, LPA printed this report at the RO and emailed it to Director. See file for acknowledgement receipt.

On 12/01/2022 at 11:00am, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced case management inspection, for Action Level Exceedance (ALE) detected in facility's water fixture. LPA met with Director, Michelle Zamora. Also present in the facility were 79 children and 18 teachers/staff. Facility was within ratio & capacity.

Per 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.



Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA on 11/01/22.

On 11/18/2022, 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 10/01/2022.



There were 5 Bubbler Water Fountains that were reported with 5.5 ppb or greater lead exceedance levels as follows:
  • GG- Drinking Fountain in Room 106 yard (15 UG/L)- permanently removed & inoperable
  • H- Drinking Fountain in Room 105 (12 UG/L)- permanently removed & inoperable
  • P- Drinking Fountain in Room 111 (6.5 UG/L)- permanently removed & inoperable
  • Q- Drinking Fountain in Room 111 (9.9 UG/L)- permanently removed & inoperable
  • R- Drinking Fountain in Room 111 yard (7.3 UG/L)- permanently removed & inoperable
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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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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: ASSOCIATED STUDENTS CHILD CARE CENTER
FACILITY NUMBER: 370805130
VISIT DATE: 12/01/2022
NARRATIVE
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Director stated that all bubbler water fountains have not been used or operable since March of 2020, if not earlier. After receiving the test results, facility immediately posted the results at the facility on 10/21/22, 24 hours of receipt of the testing results. Alternatively, drinking water is being provided only from sinks and drinking fountains on site that have been tested and confirmed to be below the Action Level for lead. As a permanent plan of correction, the facility has removed all outlets with Action Level exceedances effective 10/28/22. During inspection, LPA observed all the outlets to be removed and permanently inoperable.

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 deficiency cited.

Exit interview conducted and report was reviewed with the facility representative, Michelle Zamora. A copy of PIN 21-21-CCP was provided to facility today. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2022 02:55 PM - It Cannot Be Edited


Created By: Samantha Clenista On 12/01/2022 at 08:59 AM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ASSOCIATED STUDENTS CHILD CARE CENTER
FACILITY NUMBER: 370805130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2022
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., 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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Director stated the outlet has not been in use since March 2022. Facility immediately posted the results at the facility on 10/21/22, 24 hours of receipt of the testing results. Since receiving the results, the facility
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Based on record review, the facility did not comply with the directive above, 5 Bubbler Water Fountains outlets tested with an Action Level Exceedance (ALE). This poses a Potential Health and Safety risk to children in care.
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has removed all outlets that had Action Level exceedances effective 10/28/22. During inspection, LPA observed all mentioned outlets to be removed and permanently inoperable. POC cleared during visit.

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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 Cuddy
LICENSING EVALUATOR NAME:Samantha Clenista
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022


LIC809 (FAS) - (06/04)
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