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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006237
Report Date: 04/26/2023
Date Signed: 04/26/2023 10:30:49 AM

Document Has Been Signed on 04/26/2023 10:30 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
372006237
ADMINISTRATOR:BRE MANATAFACILITY TYPE:
850
ADDRESS:643 W. 13TH AVETELEPHONE:
(760) 747-3029
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 155TOTAL ENROLLED CHILDREN: 155CENSUS: 54DATE:
04/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Darlene Beebe, DirectorTIME COMPLETED:
10:45 AM
NARRATIVE
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On April 26, 2023, at 9:35 a.m., Licensing Program Analyst (LPA) Cindy Hamilton made an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Grace Lutheran Preschool Director, Darlene Beebe and proceeded to tour the facility. Also present in the facility were 54 daycare children and 9 teachers/staff. Facility was within ratio & capacity. Staff members have the required background clearances.

LPA interviewed the director and examined the sink with the drinking fountain and faucet combination in Room 10 (Butterflies Room) deemed an Action Level Exceedance (ALE). Per the Director and the results only the drinking fountain was deemed an ALE. The required signed and dated forms (LIC 9275/9276), were submitted to Community Care Licensing via email on 04/11/23 along with LIC 999 Facility Sketch.

Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows:
Unit C – drinking fountain located in Room 410 (Butterflies Room) - 6.0 ppb

All other fountains and water outlets tested within an acceptable level with no lead exceedance. Parents were notified via the parent communication board where the results are posted. The director reported that the drinking fountain in exceedance (Unit C) was discontinued from use and bagged on 3/30/23. At time of inspection LPA observed that the drinking fountain (Unit C) had been bagged with signage stating out of use. The director states that drinking water is available throughout the facility. Brita filtered water dispensers are located in all the classrooms. The office also has a filtered water dispenser that is readily available for use by children and staff. The director states that staff will fill a Brita water pitcher using the filtered water to refill the children's water bottles throughout the day for indoor and outdoor use.

See LIC809D cited deficiencies.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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 3
Document Has Been Signed on 04/26/2023 10:30 AM - It Cannot Be Edited


Created By: Cindy Hamilton On 04/26/2023 at 10:12 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 372006237

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1)(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up...(1) 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 stated drinking fountain, Unit C will be capped off and Director will provide proof to LPA Hamilton via email on or before the POC due date.
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LPA Hamilton received the facilities water testing results for faucets with an Action Level Exceedance higher than the allowable limit.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023


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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 372006237
VISIT DATE: 04/26/2023
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LPA Hamilton informed Director Beebe that this report dated 04/26/2023 documents one Type B citation.

Exit interview conducted, this report and appeal rights were reviewed with Director Darlene Beebe. A notice of site visit was given and must remain posted for 30 days. LPA observed Director Beebe post notice of site visit.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC809 (FAS) - (06/04)
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