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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600638
Report Date: 09/23/2022
Date Signed: 09/27/2022 01:41:51 PM

Document Has Been Signed on 09/27/2022 01:41 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:CHILDTIME CHILDREN'S CENTER - CHULA VISTA INFANTFACILITY NUMBER:
376600638
ADMINISTRATOR:JESSICA DORNFACILITY TYPE:
830
ADDRESS:770 RANCHO DEL REY PARKWAYTELEPHONE:
(619) 397-0165
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 11DATE:
09/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Jessica DornTIME COMPLETED:
02:15 PM
NARRATIVE
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On 9/23/22 at 12:50 PM LPA Adrian Castellon made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director Jessica Dorn. LPA interviewed director and examined the faucets deemed an Action Level Exceedance.

Faucet reported with 5.5 ppb or greater lead exceedance levels were as follows:

Toddler 1 Classroom Faucet E (not in use; in storage room) 5.72 ppb

Director stated faucet has not been used since in years. The faucet is located in a storage room behind a locked door. Director states that faucet will be flushed multiple times daily for a period of three weeks. Director has emailed the testing company for retesting but has not received a response. All staff have been informed not to use the faucet 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 09/27/2022 01:41 PM - It Cannot Be Edited


Created By: Adrian Castellon On 09/23/2022 at 01:48 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: CHILDTIME CHILDREN'S CENTER - CHULA VISTA INFANT
FACILITY NUMBER: 376600638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/30/2022
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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Faucet has always been made inaccessible to children in care. Faucet has been replaced by facility maintenance technician. Director has contacted testing company to schedule retest.
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Based on water testing results and interview, facility tested over the Action Level Exceedance level at 5 water outlets. 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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