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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701254
Report Date: 05/25/2023
Date Signed: 05/25/2023 09:29:40 AM

Document Has Been Signed on 05/25/2023 09:29 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:MAAC GOSNELLFACILITY NUMBER:
376701254
ADMINISTRATOR:BRENDA HOLLANDFACILITY TYPE:
830
ADDRESS:139 GOSNELL WAYTELEPHONE:
(760) 736-3066
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 1DATE:
05/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Brenda HollandTIME COMPLETED:
09:35 AM
NARRATIVE
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On 5/25/23 at 8:25 a.m., Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Director, Brenda Holland and proceeded to tour the facility. Also present in the facility was one daycare child and one teacher/staff. Facility was within ratio & capacity. LPA interviewed staff and examined the faucets and drinking fountains deemed an Action Level Exceedance. A water sample was collected from the facility on 2/2/2023. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on 2/8/2023.

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

Classroom #4 Drinking Fountain 11.10 ppb

Director reported, the drinking fountain in exceedance was permanently removed on 2/7/2023. Prior to removal, the fountain was covered by a bag and made inaccessible to children and staff. All staff were informed not to use the water from the fountain for drinking water or food/bottle preparation. The director states that the facility provides filtered water to the children in age-appropriate cups. Food preparation takes place in the kitchen using water that meets state requirements. LPA observed a copy of the facility’s water testing report posted on the parent/licensing bulletin board located in the facility office. LPA also observed that the drinking fountain has been removed.

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the facility representative, Director Holland. A copy of the Lead Sampling Results as reported in the Child Care Center Lead Sampling and Reporting Tool were provided to the Director. 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: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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 2
Document Has Been Signed on 05/25/2023 09:29 AM - It Cannot Be Edited


Created By: Grace Curtis On 05/25/2023 at 09:05 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: MAAC GOSNELL
FACILITY NUMBER: 376701254

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2023
Section Cited
CCR
101700.3(b)(2)

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Written Directives: 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, for the health and safety of children in care
This requirement is not met as evidenced by:
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Director reported, the drinking fountain in exceedance was permanently removed on 2/7/23. Prior to removal, the drinking fountain was covered to make it inaccessible to children and staff.
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On 02/02/2023, licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for: Classroom #4 Drinking Fountain. 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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The facility provides filtered water in age-appropriate cups to the children. Food preparation takes place in the kitchen using water which meets state requirements. Deficiency has been corrected.

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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: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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