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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700685
Report Date: 10/14/2022
Date Signed: 10/15/2022 12:07:04 PM

Document Has Been Signed on 10/15/2022 12:07 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:SACRED HEART ACADEMY PRESCHOOLFACILITY NUMBER:
376700685
ADMINISTRATOR:REBECCA GODINAFACILITY TYPE:
850
ADDRESS:4895 SARATOGA AVENUETELEPHONE:
(619) 222-7252
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY: 137TOTAL ENROLLED CHILDREN: 55CENSUS: 47DATE:
10/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rebecca GodinaTIME COMPLETED:
04:10 PM
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On 10/14/22 at 2:30pm, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced case management inspection for the Action Level Exceedance (ALE) of lead detected in a facility water fixtures. LPA met with facility Director, Rebecca Godina. The purpose of the inspection was explained and facility was toured. Present in facility were 47 children and six (6) staff members.

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.

LPA obtained copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276) and Facility Sketch (LIC999) on 8/30/22.

On 09/14/22 the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The facility was inspected and samples were collected on 8/30/22. The outlets/fixtures reported with 5.5 ppb or greater lead exceedance levels were as follows:

B – Sink Faucet, Basement, is not currently used for drinking water or food prep

Facility Director, Rebecca Godina stated the basement sink is in an off-limits area for children. Ms. Godina stated the sink is no longer utilized for drinking water or food prep. Ms. Godina stated all staff have been made aware of the ALE in the basement sink and will continue to not utilize the sink for drinking water or food prep. Ms. Godina placed an ‘out of service’ sign on the sink and the water was turned off.
See LIC809C continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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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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: SACRED HEART ACADEMY PRESCHOOL
FACILITY NUMBER: 376700685
VISIT DATE: 10/14/2022
NARRATIVE
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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 Director, Rebecca Godina that this report dated 10/14/22 documents one (1) Type A citation on the LIC809-D which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the facility director to provide a copy of this licensing report dated 10/14/22 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director, Rebecca Godina. 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: Martha Malane
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2022 12:07 PM - It Cannot Be Edited


Created By: Martha Malane On 10/14/2022 at 03:21 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: SACRED HEART ACADEMY PRESCHOOL
FACILITY NUMBER: 376700685

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
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.
This requirement is not met as evidenced by:
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The facility has made the outlet that tested with an ALE out of service and posted appropriate signage. Director stated they will repair the impacted outlet and fixture. Director stated that children in care are provided with alternative potable water, by using facilities water filtering system.
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Based on record review, the licensee did not comply with the directive above, as one (1) outlet used for drinking and/or food preparation tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to children in care.
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Director stated that parents will be notified of the lead exceedances via email. Director stated the POC will be provided to the San Diego Regional Office no later than 11/14/22.

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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:Tulam Vu
LICENSING EVALUATOR NAME:Martha Malane
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022


LIC809 (FAS) - (06/04)
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