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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370182
Report Date: 01/13/2023
Date Signed: 01/13/2023 10:36:59 AM

Document Has Been Signed on 01/13/2023 10:36 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 COLLEGE PARK PRESCHOOLFACILITY NUMBER:
304370182
ADMINISTRATOR:NGYUEN, KIMBERLYFACILITY TYPE:
850
ADDRESS:2380 NORTE DAME ROADTELEPHONE:
(714) 424-7960
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
01/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Michelle O'Neill, CoordinatorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Mila Quinto conducted a case management visit. LPA met with Coordinator, Michelle O’Neill to discuss the Lead Sampling Testing conducted on 12/03/2022. The Coordinator advised on 1/11/23 that the Lead Sample Report was to be posted. The Coordinator provided LPA’s copies of all documentation requested regarding Lead; LIC 999 Facility Sketch, LIC 9275 and LIC 9276. LPA confirmed the Lead Sample Report was posting during today’s visit.

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 observed outlet C in the staff break room were made inoperable via plastic cover with a sign “Do Not Use.” Outlet C is a sink in the staff break room. This room is off limit to children in care and were not used for drinking and food preparation.



Based on LPAs observation, there was no deficiencies found.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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 COLLEGE PARK PRESCHOOL
FACILITY NUMBER: 304370182
VISIT DATE: 01/13/2023
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Exit interview conducted and report was reviewed with the Director, Jamila Rivers. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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