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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600051
Report Date: 12/09/2022
Date Signed: 04/14/2023 03:41:29 PM

Document Has Been Signed on 04/14/2023 03:41 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:SOUTH BAY FAMILY YMCA-CHULA VISTA HILLS ELEMENTARYFACILITY NUMBER:
376600051
ADMINISTRATOR:BLANCA RINCONFACILITY TYPE:
840
ADDRESS:980 BUENA VISTA WAYTELEPHONE:
(619) 482-7066
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 11DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Blanca RinconTIME COMPLETED:
04:30 PM
NARRATIVE
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THIS IS AN AMENDED REPORT OF AN ORIGINAL INSPECTION CONDUCTED ON 12/9/22***

On 12/09/2022 at approximately 12:30 PM, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of lead detected in a facility water fixture. LPAs met with site supervisor Blanca Rincon. The purpose of the inspection was explained, and facility was toured. Present in facility were 11 children with 2 staff.

LPA discussed 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 site supervisor 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.

LPA Castellon has not received copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999).

On 11/23/2022 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 11/9/2022. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels were as follows:

B – Drinking faucet and hand washing faucet located in YMCA room 705 , not currently in use, but previously used.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SOUTH BAY FAMILY YMCA-CHULA VISTA HILLS ELEMENTARY
FACILITY NUMBER: 376600051
VISIT DATE: 12/09/2022
NARRATIVE
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Department Head Director Miriam Martinez stated that stated that the sink spiget has been replaced and ready for re-testing but they still have both faucets inaccessible until retest.

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.

LPA informed facility representative Becky Green that this report dated 12/07/2022, documents one (1) Type A citation on the attached 809-D.

LPA advised Site Director Rincon that parents must be notified of the lead exceedances. Licensees shall post testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility within 24 hours of receiving the results from the Department.

Exit interview conducted and report was reviewed with Site Director. A copy of this report, along with Appeal Rights (LIC9058 03/22), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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Document is an Amendment of Original Document on 04/14/2023 01:30 PM


Created By: Adrian Castellon On 12/09/2022 at 03:25 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SOUTH BAY FAMILY YMCA-CHULA VISTA HILLS ELEMENTARY
FACILITY NUMBER: 376600051

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
12/09/2022
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers. (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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The facility has made outlet(s) that tested with an ALE out of service and posted appropriate signage. Water source spiget has been replaced. Fixture(s) are to be retested by a certified water sampler and a follow-up water sample must be taken following the protocol outlined in Written Directives, Section 101705.
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This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the directive above, as drinking faucet (water source B) in YMCA room 705 used for drinking and/or food preparation tested with an Action Level Exceedance (ALE), which may pose a Health and Safety risk to children in care.
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Director stated that no children have access to the identified fauces. Director stated that parents will be notified of the lead exceedances via email/letter/telephone call.
Director stateed the POC will be provided to the San Diego Regional Office no later than 01/06/2023.

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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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023


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