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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700726
Report Date: 01/09/2023
Date Signed: 01/09/2023 12:54:53 PM

Document Has Been Signed on 01/09/2023 12:54 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:NAZARETH PRESCHOOLFACILITY NUMBER:
376700726
ADMINISTRATOR:GEORGINA BARRAGANFACILITY TYPE:
850
ADDRESS:10728 SAN DIEGO MISSION ROADTELEPHONE:
(619) 641-7954
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 59TOTAL ENROLLED CHILDREN: 59CENSUS: 30DATE:
01/09/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Georgina BarraganTIME COMPLETED:
01:05 PM
NARRATIVE
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On 1/9/23 at 12:01 PM, LPA Keturah Lane conducted a case management inspection for the purposes of a lead testing exceedance that was reported at the facility. The water outlets were tested on 5/20/22 and results were received 8/10/22. One out of five outlets tested had a lead exceedance. The outlet in exceedance was a drinking fountain connected to a sink in classroom #3.

Back on 8/15/22, LPA Tyra Block received an email from Georgina Barragan with lead results. Sample ID - C, Drinking Fountain Room 3 had ALE with lead result of 6.50 Ug/L.

LIC9275 & LIC9276 forms, sketches and plan of correction was submitted to the Department in August 2022.

Director stated that at the time of exceedance in August 2022, the classroom was not being used due to a fresh coat of paint. The outlet in exceedance was covered with a ziploc bag and taped off (see photo) to make inaccessible to children. Director stated that children bring reusable water bottles which are refilled as needed from two 5-gallon cold purified drinking water dispensers. If a child does not bring a bottle, the facility provides a small, sealed water bottle. Children resumed using the classroom on November 7, 2022. Director stated the faucet will continue to be ceased and covered permanently.

Pursuant to Title 22 CA Code of Regulations, the following Type B deficiency was cited (refer to LIC809-D...). Corrections for the deficiency have already been received.

Exit interview conducted and report was reviewed with facility representative Director Georgina Barragan. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2023
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 01/09/2023 12:54 PM - It Cannot Be Edited


Created By: Keturah Lane On 01/09/2023 at 12:26 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: NAZARETH PRESCHOOL
FACILITY NUMBER: 376700726

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3 Lead Testing Written Directives (b)(1) "A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by...
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Director corrected the deficiency by covering and taping off the outlet in exceedance in August 2022. The outlet will be permanently out of use. Children bring water bottles and they are refilled from purified drinking water dispensers at the facility.
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Based upon documents received via e-mail from Director, one out of five outlets tested for a lead exceedance which is a potential health, safety and 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023


LIC809 (FAS) - (06/04)
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