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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700496
Report Date: 01/18/2023
Date Signed: 01/18/2023 12:55:34 PM

Document Has Been Signed on 01/18/2023 12:55 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BETH MONTESSORIFACILITY NUMBER:
376700496
ADMINISTRATOR:LINA WOLFFACILITY TYPE:
850
ADDRESS:8660 GILMAN DRIVETELEPHONE:
(858) 452-3030
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 98DATE:
01/18/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lina Wolf & Cecilia KrongoldTIME COMPLETED:
01:15 PM
NARRATIVE
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On 1/18/23 at 11:30 AM, Licensing Program Analyst (LPA) Keturah Lane conducted a case management inspection for the purposes of a lead testing exceedance that was reported at the facility. The water outlets were tested on 12/6/22 and results were received 12/16/22 via telephone (last day before winter break). Written tests results were received after returning from break. The school was closed for break 12/17/22 - 1/3/23. Four of the 12 outlets tested had a lead exceedance. Facility is in the process of flushing the sinks for retesting. LIC9275, LIC9276, sketches, photos, written plan of correction and additional information was submitted to the Department on 1/6/23. Sinks with lead exceedance are used for hand-washing only and signs have been posted to not use the sinks for drinking or food prep. Director stated that 3 out of the 4 sinks tested had just had fixtures replaced and the technician from the testing company stated that sometimes new fixtures test positive for lead because there is residue lead from the manufacturing process. These faucets do not need to be replaced again, but they should be flushed. Classrooms with the affected sinks have a flushing schedule posted that began on 1/4/23. The flushing process takes 3-4 weeks and then the affected sinks will be tested again. Children are bringing reusable water bottles from home that are refilled as needed from the water filter in the lounge (outlet L) that was not affected by the lead exceedance.

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 facility representative Cecilia Krongold. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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 01/18/2023 12:55 PM - It Cannot Be Edited


Created By: Keturah Lane On 01/18/2023 at 12:46 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: BETH MONTESSORI
FACILITY NUMBER: 376700496

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3 Lead Testing Written Directives (b)(1) "A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by...
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Director corrected the deficiency by posting signs that affected sinks are not to be use for drinking or food prep. Facility is undergoing flushing procedure to have sinks retested. Children bring water bottles from home and they are refilled from purified drinking water dispenser in the teacher lounge.
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Based upon documents received via e-mail from Director, four out of 12 outlets tested for a lead exceedance which is a potential health, safety and personal rights 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.
SUPERVISOR'S NAME:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023


LIC809 (FAS) - (06/04)
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