<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600992
Report Date: 05/15/2023
Date Signed: 05/15/2023 10:01:19 AM

Document Has Been Signed on 05/15/2023 10:01 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:NHA URBAN VILLAGE II HEAD STARTFACILITY NUMBER:
376600992
ADMINISTRATOR:BRENDA WEBB PATTYFACILITY TYPE:
850
ADDRESS:4305 UNIVERSITY AVENUE STE 107TELEPHONE:
(619) 284-5644
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 88TOTAL ENROLLED CHILDREN: 88CENSUS: 57DATE:
05/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Director Brenda PattyTIME COMPLETED:
09:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 15th, 2023, at 8:00 AM, Licensing Program Analyst (LPA) JoAnn Legaspi conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of lead detected in a facility water fixture. LPA met with Director Brenda Patty. The purpose of the inspection was explained, and facility was toured. Present in facility were fifty-seven (57) children with twenty-one (21) 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 director 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.

The Department obtained copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999).

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 08/31/2022. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels were as follows:

A- Room 1 Sink.

Staff reported the sink was replaced and its water was retested. The retest results revealed the outlet to be within appropriate levels. Staff were made aware of the ALE in the room sink and have not utilized the sink for drinking water or food preparation. The director states the sink was only used by teachers for hand washing.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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
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: NHA URBAN VILLAGE II HEAD START
FACILITY NUMBER: 376600992
VISIT DATE: 05/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Grant funding was 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 Director Patty that this report dated 05/15/2023 documents one (1) Type B citation on the attached 809-D.

LPA advised Director Patty that parents must be notified of the lead exceedances. Licensee 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. Director states parents have already been notified of the lead exceedances and results posted.

Exit interview conducted and report was reviewed with Director Patty. A copy of this report, along with Appeal Rights (LIC9058), 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: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 05/15/2023 10:01 AM - It Cannot Be Edited


Created By: JoAnn R Legaspi On 05/15/2023 at 04:46 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: NHA URBAN VILLAGE II HEAD START
FACILITY NUMBER: 376600992

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2023
Section Cited

101700.3

1
2
3
4
5
6
7
CA. Lead Action Level at CCC – “ … Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.” This requirement is not met as evidenced by: On 08/31/22, Lic. did not keep
1
2
3
4
5
6
7

The facility replaced the outlet that tested with an ALE. The fixture was retested by a certified water sampler and a follow-up water sample taken following the protocol outlined in Written Directives, Section 101705. Director said that children in care are given alternative potable
8
9
10
11
12
13
14
a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for Room 1 sink. Water testing results identified with Action Level Exceedance (ALE) as defined in WD section 101700.3. are not deemed safe to drink. Based on a record review, the Lic. didn't comply with the above directive; Room 1 sink tested with an ALE. This poses as a potential Health & Safety risk to children in care.
8
9
10
11
12
13
14

water, by using alternate outlets, specifically water cooler. Director said parents were notified of the lead exceedances via letter and posting. On 05/10/2023, the outlet was retested to be within appropriate levels. This deficiency has been cleared.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Tulam Vu
LICENSING EVALUATOR NAME:JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3