ADOBE BLUFFS PRESCHOOL

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 4/21/23 at 12:16pm, LPA Annette Sutherland made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with staff member Daisy Cai. Also present in the facility were 18 daycare children and 3 teachers/staff in 1 room. Facility was within ratio & capacity. LPA interviewed Ms. Daisy and examined the faucet deemed an Action Level Exceedance. Faucet reported with 5.5 ppb or greater lead exceedance levels was as follow: Drinking fountain on black top         6.600 ppb Faucet in exceedance is a drinking fountain is not currently being used for drinking. Drinking fountains on black top are covered with bags, making them inaccessible to children. Children bring water bottles to school each day and the facility provides bottled water to refill the bottles.  See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative Daisy Cai. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Monica Cuddy LICENSING EVALUATOR NAME: Annette Sutherland LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023 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: ADOBE BLUFFS PRESCHOOL FACILITY NUMBER: 376700300 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/21/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/21/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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:1 2 3 4 5 6 7Corrections were made prior to testing. Drinking faucets have not been used prior tocovid. Bags are wrapped around drinking faucets. Children bring their own water bottles to school , facility will provide additional water with filtered water bottles if needed. 8 9 10 11 12 13 14Based on water testing results and interviews, facility tested over the Action Level Exceedance at one drinking fountain that has not beein used for dinking prior to covid. This poses an potential health, safety or personal rights risk to children 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:Monica Cuddy LICENSING EVALUATOR NAME:Annette Sutherland LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023

Type B citation - potential risk if not corrected

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 4/21/23 at 12:16pm, LPA Annette Sutherland made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with staff member Daisy Cai. Also present in the facility were 18 daycare children and 3 teachers/staff in 1 room. Facility was within ratio & capacity. LPA interviewed Ms. Daisy and examined the faucet deemed an Action Level Exceedance. Faucet reported with 5.5 ppb or greater lead exceedance levels was as follow: Drinking fountain on black top         6.600 ppb Faucet in exceedance is a drinking fountain is not currently being used for drinking. Drinking fountains on black top are covered with bags, making them inaccessible to children. Children bring water bottles to school each day and the facility provides bottled water to refill the bottles.  See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative Daisy Cai. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Monica Cuddy LICENSING EVALUATOR NAME: Annette Sutherland LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023 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: ADOBE BLUFFS PRESCHOOL FACILITY NUMBER: 376700300 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/21/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 04/21/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(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:1 2 3 4 5 6 7Corrections were made prior to testing. Drinking faucets have not been used prior tocovid. Bags are wrapped around drinking faucets. Children bring their own water bottles to school , facility will provide additional water with filtered water bottles if needed. 8 9 10 11 12 13 14Based on water testing results and interviews, facility tested over the Action Level Exceedance at one drinking fountain that has not beein used for dinking prior to covid. This poses an potential health, safety or personal rights risk to children 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:Monica Cuddy LICENSING EVALUATOR NAME:Annette Sutherland LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023