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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701396
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:04:18 PM

Document Has Been Signed on 10/04/2022 02:04 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:KINDERHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
376701396
ADMINISTRATOR:ALEXANDRA POPFACILITY TYPE:
850
ADDRESS:6540 FLANDERS DRIVETELEPHONE:
(858) 550-0097
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 69DATE:
10/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Alexandra PopTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/04/22 at 1:51 PM , LPA Annette Sutherland made an unannounced Case Management Inspection due to reported Lead Exceedance levels in the facility's water. LPAs met with Director, Alexandra Pop. There were 69 children and 11 staff present in 7 rooms. Children were napping.

Water outlet reported with 5.5 ppb or greater lead exceedance levels as follows:

Drinking Fountain Playground #2 (8.20 UG/L)

LPAs observed taped bag making it inaccessible during visit. Director stated that she will replace all outside water fountains on the playground and have them re-tested before use to show the fountain are below the exceedance lead level.

See LIC 809D for Type A deficiency.

LPA Annette Sutherland informed facility representative Alexandra Pop that this report dated 10/4/22 documents 1 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Annette Sutherland informed the facility representative Alexandra Pop to provide a copy of this licensing report dated 10/4/22 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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 10/04/2022 02:04 PM - It Cannot Be Edited


Created By: Annette Sutherland On 10/04/2022 at 12:08 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: KINDERHOUSE MONTESSORI SCHOOL
FACILITY NUMBER: 376701396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2022
Section Cited

101700.3(b)(1)

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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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Director states that this water fountain has been made inaccessible since the pandemic started and that all water fountains located in the playground will be replaced. Director will keep Licensing informed of the progress.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance level at on water fountain on playground #2. This poses an immediate/potential 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
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