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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213440
Report Date: 11/21/2022
Date Signed: 11/21/2022 04:22:57 PM

Document Has Been Signed on 11/21/2022 04:22 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOOD SHEPHERD LUTHERAN EARLY CHILDHOOD CENTERFACILITY NUMBER:
566213440
ADMINISTRATOR:VERONICA MARINFACILITY TYPE:
850
ADDRESS:380 ARNEILL ROADTELEPHONE:
(805) 482-3411
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 26DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Jasmine MunguiaTIME COMPLETED:
04:38 PM
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On November 21, 2022 at 3:00 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection to follow-up on an Action Level Exceedance (ALE) reported to the Regional Office by Division of Drinking Water (DDW). LPA met with facility Director, Jasmine Munguia and advised her the purpose of the inspection. Director provided LPA a tour of the facility. There were 26 children in care at the time of the inspection.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five (5) years after the date of the first test. If the water testing results indicate that the facility has an ALE, an immediate response shall be required pursuant to section 101704, which may include remediation.

The Regional Office received an ALE for one (1) water outlet in this facility. Location "F" had an ALE of 21.0 ppb. Director advised the location had been secured preventing children/staff from having access. The drinking fountain valve was removed from the sink. Director advised that the valve had been broken and taped-off since they transferred to the facility in 2017.

During today’s inspection, LPA toured the facility and inspected the outlet in question. LPA observed that the one (1) outlet had been removed and taped off. Director advised the facility does not plan to replace the outlet. Director advised the facility has a local vendor deliver bottled water and has been providing children/staff water for the past three (3) years. Prior to bottle water, the facility used a different water source that did not test with an ALE.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOOD SHEPHERD LUTHERAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 566213440
VISIT DATE: 11/21/2022
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LPA advised Director that children must not have access to the outlet. Should the facility decide to replace the outlet in the future for children in care, they must retest the outlet to ensure the ALE has been corrected. LPA reviewed the Provider Information Notice (PIN) 21-21-CCP "Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370."

Per PIN 21-21-CCP, the following outlet locations should be sampled: cold water faucets and fountains, cold water side of single-handle and dual-handle faucets that dispense both hot and cold water, filtered water dispensers, and water dispensed by refrigerators used for drinking and cooking water. The facility provides water for children/staff in the facility purchased from a local vendor.

No deficiency was cited during today's inspection.

Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
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