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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700079
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:50:47 PM

Document Has Been Signed on 08/16/2023 02:50 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CARLSBAD EDUCATIONAL FOUNDATION - KELLY ELEMENTARYFACILITY NUMBER:
376700079
ADMINISTRATOR:IZABELLA ROMOFACILITY TYPE:
840
ADDRESS:4885 KELLY DRIVETELEPHONE:
(760) 331-5865
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 0DATE:
08/16/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:April SmithTIME COMPLETED:
03:10 PM
NARRATIVE
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On 08/16/2023 at 2:30pm, Licensing Program Analyst (LPA), Samantha Clenista conducted an unannounced case management inspection for the purposed to address the facility not testing their water faucets for lead. Upon arrival, LPA met with April Smith, Area Manager.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Ms. Smith stated that the facility currently and has (last school year) used the water fountains placed throughout the school campus and refillable water jugs and water bottles for the children to drink. Ms. Smith stated that no water faucets that are used for food preparation. Based on record review and interview with Ms. Smith, it was confirmed that facility has not tested their water for lead per AB2370.

See 809D for Type B citation issued during time of inspection. A notice of site visit was given and must remain posted for 30 days. Failure to keep notice posted will result in a civil penalty of $100.00. Exit interview conducted and report was reviewed with Ms. Smith. As a reminder, all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619) 767-2203.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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 08/16/2023 02:50 PM - It Cannot Be Edited


Created By: Samantha Clenista On 08/16/2023 at 02:19 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: CARLSBAD EDUCATIONAL FOUNDATION - KELLY ELEMENTARY
FACILITY NUMBER: 376700079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
HSC
1597.16(a)(1)

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...(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020... This requirement is not met as evidenced by;
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Ms. Smith stated she will consult with upper management to schedule an inspection with a company to have the facility's water faucets (used for drinking and/or food preparation) tested for lead contamination
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Based on record review and interview with Director, facility has not tested their water for lead. LPA during inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
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and will provide LPA a confirmation of when the inspection is scheduled by POC due date.

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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:Tashima Daniel
LICENSING EVALUATOR NAME:Samantha Clenista
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023


LIC809 (FAS) - (06/04)
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