<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000311
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:24:42 PM

Document Has Been Signed on 06/05/2024 01:24 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LA JOLLA PRESBYTERIAN CHURCH PRESCHOOLFACILITY NUMBER:
372000311
ADMINISTRATOR/
DIRECTOR:		BARBARA ETIENNEFACILITY TYPE:
850
ADDRESS:7715 DRAPER AVENUETELEPHONE:
(858) 454-2677
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: DATE:
06/05/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Barbara EtienneTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/5/2024 @ 12:20 PM., Licensing Program Analyst (LPA), Sherlynn Banas, made an unannounced case management inspection for a reported lead exceedance. LPA Banas met with Barbara Etienne (Director) There were 14 children and 5 staff in the classroom. Room 1 has 4 children with 2 qualified teachers (Staff 1 and 2). Room 2 has 5 children with 2 qualified teachers (staff 3 and 4). Room 3 is empty. Room 4 has 5 children and 1 qualified teachers (staff 5) and and administrator (staff 6). Room 5 is empty (used only for Sunday school). The facility was in ratio. LPA interviewed 3 teachers (staff 2,4 and 5). All teachers stated that the sink was not used for food preparation and drinking. They use the bathroom sink for hand washing and drinking water was in a filtered pitcher with cups. LPA examined the Sink D with the lead exceedance result.

Per the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs). Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

Faucet reported with 5.5 ppb or greater lead exceedance level was as follows:

Classroom 3 Sink: used for drinking water and food preparation. Testing conducted on 2/8/2024 and result received on 2/14/2024 5.6 ppb.

Facility immediately discontinued the use of the faucet for any food preparation or drinking purpose. A sign saying "STOP- Water faucet out of order" has been placed at the faucet.

Based on the information initially provided that the facility had a lead exceedance and newly received information that the Office of Water Programs, that the faucet/outlet was used for drinking water and/or food preparation.


SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LA JOLLA PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 372000311
VISIT DATE: 06/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Barbara Etienne stated that the faucet will be retested. The results will be reported to Licensing.


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 Director, Barbara Etienne. NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/05/2024 01:24 PM - It Cannot Be Edited


Created By: Sherlynn Banas On 06/05/2024 at 01:03 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: LA JOLLA PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 372000311

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2024
Section Cited

101700.3(b)(1)

1
2
3
4
5
6
7
Written Directives: A result with of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director stated that they have made the sink inaccessible by putting a "STOP" sign covering the faucet. Alternative handwashing sink in the classroom bathroom was used. Retesting will be done and report will be provided to Licensing.
8
9
10
11
12
13
14
Based on water testing results, faciliy tested over the Action Level Exceedance in Room 3. This poses a potential health, safety or personal rights risk to 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:Tashima Daniel
LICENSING EVALUATOR NAME:Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3