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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000473
Report Date: 12/07/2022
Date Signed: 12/07/2022 01:36:46 PM

Document Has Been Signed on 12/07/2022 01:36 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:RANCHO BERNARDO COMMUNITY CHURCH PRESBYTERIAN PREFACILITY NUMBER:
372000473
ADMINISTRATOR:KIM VANDERGRIFTFACILITY TYPE:
850
ADDRESS:17010 POMERADO ROADTELEPHONE:
(858) 487-0824
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 20DATE:
12/07/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Kim VandergriftTIME COMPLETED:
01:45 PM
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On 12/07/2022 at 12:12pm, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced case management inspection, for Action Level Exceedance (ALE) detected in facility's water fixture. LPA met with Director, Kim Vandergrift. Also present in the facility were 19 day care children at the playground and 6 teachers/staff supervising the children. One day care child was in room 143 with two staff members. Facility was within ratio during the tour and all staff members have the required background clearances and are associated to the facility.

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 LIC999 to LPA via email on 12/01/2022. Director has been trying to obtain the External Water Sampler Self-Certification LIC 9275 and LIC9276 Child Care Center Sampling Checklist LIC9276 from the person that did took water sample on 10/24/2022.

On 11/14/2022, 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 10/24/2022.



Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels is as follow:

Sample Site J - -Sink for food and drinking outlet located in Room 153, currently not in use.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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: RANCHO BERNARDO COMMUNITY CHURCH PRESBYTERIAN PRE
FACILITY NUMBER: 372000473
VISIT DATE: 12/07/2022
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The teacher in room 153 stated that she has not been using that sink for food prep or refill the children's water bottle this year. She stated that she uses the sink faucet in kitchen located next to her classroom. Teacher stated that she has only been using that sink to clean paint brushes and for art projects. LPA confirmed that an Out of Service sign has been placed at the sink. Director stated that she is planning to replace the faucet to a low-lead fixture and she will be looking for a plumber. LPA advised Director to submit another LIC9276 upon completion of the replacement and retest of the faucet.

Director posted the lead water testing report at the window located in the office during today's inspection.

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, Kim Vandergrift. A copy of PIN 21-21-CCP was provided to facility via email on 11/30/2022. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/07/2022 01:36 PM - It Cannot Be Edited


Created By: Selina Siao On 12/07/2022 at 11:26 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: RANCHO BERNARDO COMMUNITY CHURCH PRESBYTERIAN PRE
FACILITY NUMBER: 372000473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2022
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 that she is planning to replace the drinking and food prep fixture in room 153. In the mean time the water fixture will not be use.
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Based on record review, the facility did not comply with the directive above, as one out of eleven outlets tested with an Action Level Exceedance (ALE). The teacher in room 153 stated that she has not been using that sink to refill the children's water bottle this year as she uses the sink in the kitchen. This poses a potential health and safety risk to clients 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:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022


LIC809 (FAS) - (06/04)
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