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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105132
Report Date: 11/08/2023
Date Signed: 11/08/2023 09:44:02 AM

Document Has Been Signed on 11/08/2023 09:44 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:COASTAL SAGE MONTESSORIFACILITY NUMBER:
376105132
ADMINISTRATOR:TOMIKO SALONFACILITY TYPE:
850
ADDRESS:1400 LAS FLORES DRIVETELEPHONE:
(760) 405-4369
CITY:SAN DIEGOSTATE: CAZIP CODE:
92008
CAPACITY: 15TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
11/08/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Signe CastanedaTIME COMPLETED:
10:00 AM
NARRATIVE
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On November 8, 2023 at 8:45 a.m., LPA Leilani Curtis conducted an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Licensee Signe Castaneda. Also present in the facility were 8 daycare children with 2 teachers/staff. Facility was within ratio & capacity. Staff members have the required background clearances and are associated to the facility. LPA interviewed the licensee and examined the faucets and drinking fountains deemed an Action Level Exceedance. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on October 13, 2023 via email.

Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows:

Staff Kitchen/Food Prep-Sample Site A 6.6 ppb

Staff Kitchen/Food Prep-Sample Site A30 9.1 ppb

The licensee states that the faucet in exceedance has not been repaired or replaced because it is not used by the staff or children for food preparation or drinking, at any time. Children bring water bottles to school each day which are refilled with bottled water. The facility maintains four, five gallon containers of bottled water on site at all times and the classroom faucet (Sample Site B) passed inspection with a water lead result of 1.8 ppb. The licensee states that children bring all food and snacks from home so there is no food preparation done at the facility. All staff have been informed not to use the staff kitchen faucet for drinking water or food preparation. LPA observed that the staff kitchen is inaccessible to children via a door knob cover. Licensee provided LPA with a letter attesting to the fact that water from the staff kitchen, sample site A, is not used for food preparation or drinking. The licensee understands that if she plans or expects to begin using the staff kitchen faucet for food preparation or drinking water the lead level in the water must be remediated and Community Care Licensing Regional Office must be notified prior to its use.

See LIC809D for cited deficiency.

Exit interview conducted and report was reviewed with Licensee Signe Castaneda. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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Document Has Been Signed on 11/08/2023 09:44 AM - It Cannot Be Edited


Created By: Grace Curtis On 11/08/2023 at 09:14 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: COASTAL SAGE MONTESSORI
FACILITY NUMBER: 376105132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1) Written Directives: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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The licensee states that the staff kitchen faucet A is not used for food preparation or drinking and is inaccessible to children via a door knob cover. The licensee provided LPA a signed and dated attestation letter declaring that the staff kitchen faucet will not be used.
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Based on water testing results and licensee statement, licensee failed to maintain a lead value at or below the Action Level for water lead testing of 5.5 ppb or greater for the staff kitchen faucet A. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3. are not deemed safe to drink.
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All staff have been informed not to use the staff kitchen faucet. The children have access to bottled water and water from the classroom sink, “Site B” which meets requirements. The deficiency has been cleared.

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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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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