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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005452
Report Date: 09/30/2025
Date Signed: 09/30/2025 10:42:07 AM

Document Has Been Signed on 09/30/2025 10:42 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:OCEAN BEACH CHILD CARE - INFANTFACILITY NUMBER:
372005452
ADMINISTRATOR/
DIRECTOR:		MARIA MENDOZAFACILITY TYPE:
830
ADDRESS:2041 CHATSWORTH BOULEVARDTELEPHONE:
(619) 222-6242
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY: 24TOTAL ENROLLED CHILDREN: 17CENSUS: 15DATE:
09/30/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Maria MendozaTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
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On 9/30/25, at 9:15am, Licensing Program Analyst (LPA) Danielle Anderson and Licensing Program Manager Rajani Goudreau conducted an unannounced case management inspection for an Action Level Exceedance (ALE) of lead detected in facility water outlet. LPA met with Maria Mendoza. The purpose of the inspection was explained, and the facility was toured. Present in the facility were 15 children, 3 of which are under 24 months with 5 staff members.

LPA discussed Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires Child Care Centers (CCCs) located in buildings constructed before January 1, 2010, to have their water tested for lead and results posted by January 1, 2023, and every five years thereafter.

On 9/3/2025, the Department obtained copies of the following:

· External Water Sampler Self-Certification Form (LIC 9275),

· Child Care Center Sampling Checklist (LIC 9276), and

· Facility Sketch (LIC 999).

On 9/23/2025, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW), that samples were collected on 8/9/2025. The following outlet reported with 5.5 ppb or greater lead exceedance levels are as follows

NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Danielle Anderson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/30/2025 10:42 AM - It Cannot Be Edited


Created By: Danielle Anderson On 09/30/2025 at 09:56 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: OCEAN BEACH CHILD CARE - INFANT
FACILITY NUMBER: 372005452

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2025
Section Cited

101700.3(b)(2)

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101700.3 California Lead Action Level at Child Care Centers. (b)(2) Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives. This requirement was not met as evidenced by:
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The facility has removed the water fountain and the director stated they will not be replacing it. If the fountain is replaced in the future the director is notified that the outlet must be retested prior to the initial use.
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 On 8/09/25, Licensee failed to maintain a lead value at or below the Action Level for water lead testing. Results identified values of 5.5 ppb or greater for the drinking fountain outdoor. Outlets with Action Level Exceedance, as defined in WD 101700.3, are not deemed safe to drink. This poses a potential health and safety 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.
Rajani Goudreau
NAME OF LICENSING PROGRAM MANAGER:
Danielle Anderson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: OCEAN BEACH CHILD CARE - INFANT
FACILITY NUMBER: 372005452
VISIT DATE: 09/30/2025
NARRATIVE
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· Drinking Fountain Play Area – RESULT 12 ppb

The affected outlet are designated on the facility sketch as drinking fountain play area and are located in the play area. The drinking fountain has been removed from the facility and not replaced. Maria Mendoza stated that the fountain will not be replaced. LPA informed the director that if the fountain is replaced there must be retesting done prior to initial use to ensure lead concentrations are below the CDSS action level of 5 parts per billion (ppb).

Maria Mendoza stated that the affected outlets were not the main source of outdoor water for the children. The children use the filtered water system in the kitchen for outdoor drinking water while outside. LPA observed filtered water provided to children during the inspection.

Grant funding may be available for testing and remediation of lead in qualifying facilities. For eligibility, refer to PIN 21-04-CCP. Additional resources on Lead Testing and Prevention can be found at: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

This report documents 1 Type B citation(s) on the attached LIC 809-D. LPA advised Maria Mendoza that parents must be notified of the lead exceedances. Which the facility has already done. The Director shall post testing results in accordance with the Health & Safety Code 1596.8595(b) within 24 hours of receiving results.

Exit interview conducted and report reviewed with Maria Mendoza. A copy of this report, Appeal Rights (LIC 9058), and Notice of Site Visit were provided. The Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Rajani Goudreau
NAME OF LICENSING PROGRAM ANALYST: Danielle Anderson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC809 (FAS) - (06/04)
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