ST. MICHAEL'S EPISCOPAL SCHOOL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On March 1, 2023, at approximately 9:45 AM Licensing Program Analyst (LPA) Josiah Gathing met with Director Marty Conkle to conduct an unannounced case management inspection. During today's inspection there were 40 preschool children being supervised by 4 teachers. The purpose of today's inspection was to create a plan of correction following a report of lead exceedance in one of the facility outlets. On 12/29/2022, the facility tested water samples for lead. One water outlet sampled indicated an Action Level Exceedance (ALE). This outlet is marked B on the facility sketch provided by the center. Outlet B correlates to a drinking fountain located inside the classroom near the entrance. On January 17, 2023 the facility was notified that water levels were in exceedance of 5 parts per billion in outlet B. During today’s inspection, Director informed LPA that outlet B has not been used by children since the beginning of the COVID-19 pandemic, in March of 2020. LPA observed that all children have individual thermoses and containers for drinking water. A plan of correction is being issued to ensure that outlet B is made inoperable, removed, and/or replaced. All faucets used by preschool children have been tested and are not in Action Level Exceedance. Outlet B has been covered by a plastic bag, to make it inaccessible.. Additionally, signs have been placed on the outlet stating that it should not be used for drinking or food preparation. LPA received the lead testing map and other required documents from the Director during today's inspection. A deficiency is cited on the following LIC809-D and the plan of correction was reviewed with the Director, Marty Conkle A copy of this report and appeal rights were provided to the Director. SUPERVISORS NAME: Seychelle De Luca LICENSING EVALUATOR NAME: Josiah Gathing LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023 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 FACILITY NAME: ST. MICHAEL'S EPISCOPAL SCHOOL FACILITY NUMBER: 340300650 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/01/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 05/01/2023 Section Cited HSC 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 ...Lead Action Level... (b) ...(1) If testing indicates an Action Level Exceedance at any water outlet, the water... is deemed not safe to drink and an immediate response... shall be required. This requirement was not met as evidenced by:1 2 3 4 5 6 7Director will provide proof to the LPA that the outlet has been removed by the POC due date. Center will also notify parents about what has been done to date (e.g. signs, plans to replace outlets, etc). 8 9 10 11 12 13 14Based on record review the facility did not comply with the above regulation as the lead action level was exceeded in one water outlet, which poses Health, Safety, or Personal Rights risk to persons in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Seychelle De Luca LICENSING EVALUATOR NAME:Josiah Gathing LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On March 1, 2023, at approximately 9:45 AM Licensing Program Analyst (LPA) Josiah Gathing met with Director Marty Conkle to conduct an unannounced case management inspection. During today's inspection there were 40 preschool children being supervised by 4 teachers. The purpose of today's inspection was to create a plan of correction following a report of lead exceedance in one of the facility outlets. On 12/29/2022, the facility tested water samples for lead. One water outlet sampled indicated an Action Level Exceedance (ALE). This outlet is marked B on the facility sketch provided by the center. Outlet B correlates to a drinking fountain located inside the classroom near the entrance. On January 17, 2023 the facility was notified that water levels were in exceedance of 5 parts per billion in outlet B. During today’s inspection, Director informed LPA that outlet B has not been used by children since the beginning of the COVID-19 pandemic, in March of 2020. LPA observed that all children have individual thermoses and containers for drinking water. A plan of correction is being issued to ensure that outlet B is made inoperable, removed, and/or replaced. All faucets used by preschool children have been tested and are not in Action Level Exceedance. Outlet B has been covered by a plastic bag, to make it inaccessible.. Additionally, signs have been placed on the outlet stating that it should not be used for drinking or food preparation. LPA received the lead testing map and other required documents from the Director during today's inspection. A deficiency is cited on the following LIC809-D and the plan of correction was reviewed with the Director, Marty Conkle A copy of this report and appeal rights were provided to the Director. SUPERVISORS NAME: Seychelle De Luca LICENSING EVALUATOR NAME: Josiah Gathing LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023 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 FACILITY NAME: ST. MICHAEL'S EPISCOPAL SCHOOL FACILITY NUMBER: 340300650 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/01/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 05/01/2023 Section Cited HSC 101700.3(b)(1) 1 2 3 4 5 6 7101700.3 ...Lead Action Level... (b) ...(1) If testing indicates an Action Level Exceedance at any water outlet, the water... is deemed not safe to drink and an immediate response... shall be required. This requirement was not met as evidenced by:1 2 3 4 5 6 7Director will provide proof to the LPA that the outlet has been removed by the POC due date. Center will also notify parents about what has been done to date (e.g. signs, plans to replace outlets, etc). 8 9 10 11 12 13 14Based on record review the facility did not comply with the above regulation as the lead action level was exceeded in one water outlet, which poses Health, Safety, or Personal Rights risk to persons in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Seychelle De Luca LICENSING EVALUATOR NAME:Josiah Gathing LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023

Type B citation - potential risk if not corrected