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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001122
Report Date: 11/04/2022
Date Signed: 11/04/2022 10:38:18 AM

Document Has Been Signed on 11/04/2022 10:38 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:NOAH'S ARK PRESCHOOL OF THE CLAIREMONT COVENANT CHFACILITY NUMBER:
372001122
ADMINISTRATOR:JAIME LYNN PARKERFACILITY TYPE:
850
ADDRESS:5255 MOUNT ARARAT DRIVETELEPHONE:
(858) 571-1880
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 66TOTAL ENROLLED CHILDREN: 79CENSUS: 47DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jaime Lynn ParkerTIME COMPLETED:
10:50 AM
NARRATIVE
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On 11/4/22 at 9:30am, LPA Patrick Ma made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Jaime Lynn Parker. Also present in the facility were 47 daycare children and 10 teachers/staff in 5 rooms. Facility was within ratio & capacity. LPA interviewed director and examined the faucet deemed an Action Level Exceedance.

Faucet reported with 5.5 ppb or greater lead exceedance levels was as follow:

Classroom 4 Green Sink 9.00 ppb

Faucet in exceedance is a teacher sink out of reach of children and is not used for drinking or food preparation, but since testing Director has since posted a "Do not use for drinking or food handling" sign above the sink in exceedance to remind staff not to use the faucets for drinking water or food preparation. Director has fitted all class sinks with lead filters. Children bring water bottles to school each day and the facility provides filtered water to refill the bottles.

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative Jaime Lynn Parker.
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: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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 11/04/2022 10:38 AM - It Cannot Be Edited


Created By: Patrick Ma On 11/04/2022 at 10:25 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: NOAH'S ARK PRESCHOOL OF THE CLAIREMONT COVENANT CH
FACILITY NUMBER: 372001122

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/11/2022
Section Cited

101700.3(b)(1)

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101700.3(b)(1) Written Directives: 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 have been made by site visit. All sink faucets have been fitted with lead filters including the Green room. However, Greem sink in exceedance will not use for drinking and food prep untill his has been retested and results indicate it is below exceedance level. A sign not to use for drinking and food prep is also posted
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Based on water testing results and interviews, facility tested over the Action Level Exceedance at one sink faucet that is not used for drinking or food preparations. This poses an 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: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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