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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000610
Report Date: 09/26/2022
Date Signed: 09/26/2022 01:39:49 PM

Document Has Been Signed on 09/26/2022 01:39 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:UNIVERSITY CITY UNITED CHURCH NURSERY SCHOOLFACILITY NUMBER:
372000610
ADMINISTRATOR:JESSICA FRAZIERFACILITY TYPE:
850
ADDRESS:2877 GOVERNOR DRIVETELEPHONE:
(858) 455-0336
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 18DATE:
09/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jessica FrazierTIME COMPLETED:
01:50 PM
NARRATIVE
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On 9/26/22 at 11:45 AM, Licensing Program Analyst (LPA) Keturah Lane made an unannounced case management inspection, for reported Lead Exceedance. LPA met with Director Jessica Frazier. Also present in the facility were 18 daycare children and 4 staff members. Facility was within ratio & capacity. One staff member was not associated to the facility. LPA interviewed Director and examined the kitchen sink faucet deemed an Action Level Exceedance. The kitchen sink faucet had lead exceedance levels of 10 ug/L and 5.8 ug/L when flushed.

Director reported kitchen sink faucet in exceedance was tested prior to the children returning to the center after summer break on 9/6/22. At that point, the kitchen sink was already closed because results were received prior to 9/6/22. Previous testing in 2017 showed non-detectable levels of lead. Facility did not use the sink for drinking water or cooking because it was already closed. Director stated the facility is using bottled water for refilling water bottles and for rinsing any food. Kitchen sink is only used for handwashing and washing dishes. All staff have been informed not to use the kitchen sink for drinking water or food preparation.

See LIC809-D for Type B citations.

Exit interview conducted and report was reviewed with the facility representative Director Jessica Frazier. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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Document Has Been Signed on 09/26/2022 01:39 PM - It Cannot Be Edited


Created By: Keturah Lane On 09/26/2022 at 01:05 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: UNIVERSITY CITY UNITED CHURCH NURSERY SCHOOL
FACILITY NUMBER: 372000610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/26/2022
Section Cited

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 was not met as evidenced by...
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Director reported, kitchen sink faucet in exceedance was replaced with low lead compliant faucet and lead reduction filter and is in the process of flushing it 4 times a day for 3 weeks before having them tested again. Children bring water bottles to school and facility is using bottle water at this time. Director stated she will provide retesting documents and results to LPA Lane once provided by water sampler.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance level for the kitchen sink faucet which may have been used for drinking and food preparation prior to the lead exceedance which posed a potential health, safety or personal rights risk to children in care.
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Type B
09/28/2022
Section Cited
CCR101170(e)(2)

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by...
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Director stated she would ensure staff member S1 is associated to the facility and provide proof to Licensing by 9/28/22 via e-mail to Keturah.Lane@dss.ca.gov
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Based upon record review and Director interview, transfer of association for staff member S1 did not get completed which is a potential health, safety and 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022


LIC809 (FAS) - (06/04)
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