304270871-1-17-2023-06-CC-MQUO-CN6Q55-20230117105123

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270871
Report Date: 01/17/2023
Date Signed: 01/17/2023 10:51:33 AM

Document Has Been Signed on 01/17/2023 10:51 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	NMUSD WILSON PRESCHOOL		FACILITY NUMBER:	304270871
ADMINISTRATOR:	CAMERO, MACY		FACILITY TYPE:	850
ADDRESS:	801 WILSON STREET		TELEPHONE:	(949) 515-6995
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 13	DATE:	01/17/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Macy Camero, Director and Michelle O'Neill, Coordinator		TIME COMPLETED:	10:30 AM

NARRATIVE

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Licensing Program Analysts (LPAs) Mila Quinto and Cindy Nguyen conducted a case management visit. LPAs met with staff, Karla Luna. At 9:11am, census was taken and there were 13 preschool children. At 9:16am, Director Macy Camero arrived and discussed the Lead Sampling Testing conducted on 12/03/2022. Director was advised on 1/11/2023 that the Lead Sample Report was to be posted. Director provided LPA’s copies of all documentation requested regarding Lead; LIC 999 Facility Sketch, LIC 9275 and LIC 9276. LPA confirmed that facility had posted the Lead Sample Report during visit on 1/11/2023.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test. Community Care Licensing was notified that lead water testing conducted at the facility on 09/2722 failed allowable limit for lead. The purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE).

Instructions for required lead testing are outlined in PIN 21-21-CCP. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

Child Care Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in parts per billion (ppb) unit of measurement.

LPA’s observed outlet A outside located in the playground area. Outlet A is a drinking fountain located outside by classroom 17 facing the playground area. Director covered the outlet with plastic and posted a “Do Not Use” sign on the outlet. Children bring their own water bottle to the school and facility provides water for children in filtered pitchers and cups.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NMUSD WILSON PRESCHOOL	FACILITY NUMBER: 304270871
	VISIT DATE: 01/17/2023

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Based on LPA's observation and interview with Director, the following violation was observed and is being cited in accordance with Written Directives Section 101700.3 (b)(1) California Lead Action Level at Child Care Centers, is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with coordinator, Michelle O'Neill. A notice of site visit was given and must remain posted for 30 days. Appeal Rights and deficiency were explained. The Director was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/17/2023 10:51 AM - It Cannot Be Edited

Created By: Mila Quinto On 01/17/2023 at 10:12 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NMUSD WILSON PRESCHOOL	FACILITY NUMBER: 304270871
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/17/2023 Section Cited 101700.3(b)	1 2 3 4 5 6 7	101700.3 (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.	1 2 3 4 5 6 7	Director posted the lead sampling test results. The drinking fountain/outlet was closed off with plastic bag, taped and sign "Do not use". The Coordinator stated they will retest the outlet and provide copies of the new test results to LPA by 1/24/23.
	8 9 10 11 12 13 14	This requirement is not met evidenced by record review of the lab report analysis from Outlet A on 12/03/2022. Results indicated levels of lead in exceedance. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	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:

Patricia Magana

LICENSING EVALUATOR NAME:

Mila Quinto

LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC809 (FAS) - (06/04)

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