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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370475
Report Date: 12/09/2022
Date Signed: 12/09/2022 03:34:08 PM

Document Has Been Signed on 12/09/2022 03:34 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ST. ANDREW'S PRESBYTERIAN CHURCHFACILITY NUMBER:
304370475
ADMINISTRATOR:ZORN, JANICEFACILITY TYPE:
840
ADDRESS:600 ST. ANDREWS ROADTELEPHONE:
(949) 574-2232
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 61DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Andrea Ruth, DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nguyen Tran conducted an unannounced Case Management visit. LPA met with Director, Andrea Ruth to discuss the Lead Sampling Testing conducted on 11/07/22.

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 11/07/2022 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.

Director was advised on 12/09/22 that the Lead Sample Report was to be posted. Director stated the outlet C with a high levels of lead at 5.5 ppb, outlet K with the high level of leads 5.8 ppb, and outlet O with high level of leads 6.3 ppb, were made inoperable and the test result was posted on 12/09/2022. LPA verified that the test sample results were posted and verified documentation of the action that the facility had taken to fix identified outlets. During the time of the outlet C, K and O were out of use, Director stated that the facility was using filtered water that came from another faucet, which did not exceed the lead level, in the facility kitchen.



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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ST. ANDREW'S PRESBYTERIAN CHURCH
FACILITY NUMBER: 304370475
VISIT DATE: 12/09/2022
NARRATIVE
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(Page 2 of Report)

Based on LPA's observation, interview with Director, review of facility's sketch and documentation regarding action taken to fix the identified outlet, 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 Director Andrea Ruth. 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 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: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2022 03:34 PM - It Cannot Be Edited


Created By: Nguyen K Tran On 12/09/2022 at 02:12 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. ANDREW'S PRESBYTERIAN CHURCH
FACILITY NUMBER: 304370475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2023
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results...comparing to the Action Level. (1) A result with values of 5.5 part per billion or greater shall be deemed an Action Level Exceedance.
This requirement was not met evidenced by:
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Director stated that facility followed Written Directives and will submit all required documentation including LIC 9275, 9276, plan of correction and details of steps taken to resolve the deficiency by due date.
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Lab report analysis water from Outlet C (5.5ppb), K (5.8 ppb), and O (6.3 ppb) taken on 11/07/2022 indicated levels of lead in exceedance. This posed a potential risk to the health, safety and personal rights of 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:Rina Lopez
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022


LIC809 (FAS) - (06/04)
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