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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806443
Report Date: 03/10/2023
Date Signed: 03/10/2023 09:51:58 AM

Document Has Been Signed on 03/10/2023 09:51 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:SCHOOL OF THE MADELEINE PRESCHOOLFACILITY NUMBER:
370806443
ADMINISTRATOR:JOSEFINA FENNESSEYFACILITY TYPE:
850
ADDRESS:1930 ILLION STREETTELEPHONE:
(619) 276-6545
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
03/10/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Josefina FennesseyTIME COMPLETED:
10:00 AM
NARRATIVE
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On 3/10/23 at 8:30am, LPA Patrick Ma made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Josefina Fennessey. There were no other persons in the facility due to in-service teacher training day. LPA examined the water outlets deemed an Action Level Exceedance.

Water outlets reported with 5.5 ppb or greater lead exceedance levels were as follows:

Classroom P4 adult hand washing sink A 6.8 ppb
Classroom P4-2 adult hand washing sink E 6.2 ppb

Director reported, all outlets in exceedance were not used for food preparation or drinking water. Since testing results, the faucets were replaced, all staff have been informed not to use the faucets for drinking water or food preparation and signs were posted by the outlets reminding others they are for hand washing only. Food preparations is conducted with filtered water and drinking water is provided by a filtered water bottle refilling station.

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Josefina Fennessey. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023
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
Document Has Been Signed on 03/10/2023 09:51 AM - It Cannot Be Edited


Created By: Patrick Ma On 03/10/2023 at 09:38 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: SCHOOL OF THE MADELEINE PRESCHOOL
FACILITY NUMBER: 370806443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1) Written Directives per AB2370: 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 visit. Director reported, all faucets in exceedance were replaced and flushed 4 times a day for 3 weeks before having them tested again on 1/31/23. All staff were informed, and signs were posted not to use the faucets for drinking water or food preparation until retesting is completed and results show the outlets are no longer at or above exceedance level.
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Based on water testing results, facility tested over the Action Level Exceedance at 2 adult sinks not used for food preparation or drinking. This poses a 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2023


LIC809 (FAS) - (06/04)
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