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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600096
Report Date: 09/23/2022
Date Signed: 12/08/2022 10:53:34 AM

Document Has Been Signed on 12/08/2022 10:53 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:LA PETITE ACADEMY - EAST JFACILITY NUMBER:
376600096
ADMINISTRATOR:CELINE DEROTHSCHILDFACILITY TYPE:
850
ADDRESS:798 EAST J STREETTELEPHONE:
(619) 421-0966
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 74DATE:
09/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angelica Valdarrama TIME COMPLETED:
12:30 PM
NARRATIVE
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On 9/23/22 at 11:00am, LPA Adrian Castellon made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Assistant Director Angelica Valdarrama. Facility was within ratio & capacity. LPA interviewed assistant director and examined the water source (spigot) deemed an Action Level Exceedance.

Spigot reported with 5.5 ppb or greater lead exceedance levels is as follows:

2s and Early Preschool Playground spigot Q (not for children use) 9.6 ppb

Assistant Director stated that spigot has not been used by staff since testing results have been received. Assistant Director states that spigot in exceedance is flushed four times daily and will be retested on 10/6 and 10/7. Children have been advised to bring water bottles to school each day and the facility uses a jug with a filter to provide refills. Extra bottles are available to children that forget their water bottles. Kitchen sink faucet used for food preparation was not in exceedance. All staff have been informed not to use spigot in exceedance for drinking water or food preparation.

See LIC809D for Type B deficiency cited.

Exit interview conducted. Appeal rights were discussed and given to assistant director on this date. Notice of Site Visit was given to assistant director.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 12/08/2022 10:53 AM - It Cannot Be Edited


Created By: Adrian Castellon On 09/23/2022 at 11:54 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: LA PETITE ACADEMY - EAST J
FACILITY NUMBER: 376600096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2022
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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Spigot has been made inaccessible and is no longer in use. Spigot isroutinely flushed as required. A second testing will be completed on 10/6 and 10/7/22.
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Based on water testing results and interview, facility tested over the Action Level Exceedance level at one water outlet (spigot). This may pose a 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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022


LIC809 (FAS) - (06/04)
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