SCHOOL OF THE MADELEINE 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 3/10/23 at 8:30am, LPA Patrick Ma made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Josefina Fennessey. There were no other persons in the facility due to in-service teacher training day. LPA examined the water outlets deemed an Action Level Exceedance. Water outlets reported with 5.5 ppb or greater lead exceedance levels were as follows: Classroom P4 adult hand washing sink A 6.8 ppb Classroom P4-2 adult hand washing sink E 6.2 ppb Director reported, all outlets in exceedance were not used for food preparation or drinking water. Since testing results, the faucets were replaced, all staff have been informed not to use the faucets for drinking water or food preparation and signs were posted by the outlets reminding others they are for hand washing only. Food preparations is conducted with filtered water and drinking water is provided by a filtered water bottle refilling station. See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative Josefina Fennessey. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023 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: SCHOOL OF THE MADELEINE PRESCHOOL FACILITY NUMBER: 370806443 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/10/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) Written Directives per AB2370: 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 visit. Director reported, all faucets in exceedance were replaced and flushed 4 times a day for 3 weeks before having them tested again on 1/31/23. All staff were informed, and signs were posted not to use the faucets for drinking water or food preparation until retesting is completed and results show the outlets are no longer at or above exceedance level. 8 9 10 11 12 13 14Based on water testing results, facility tested over the Action Level Exceedance at 2 adult sinks not used for food preparation or drinking. This poses a 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023

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 3/10/23 at 8:30am, LPA Patrick Ma made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Josefina Fennessey. There were no other persons in the facility due to in-service teacher training day. LPA examined the water outlets deemed an Action Level Exceedance. Water outlets reported with 5.5 ppb or greater lead exceedance levels were as follows: Classroom P4 adult hand washing sink A 6.8 ppb Classroom P4-2 adult hand washing sink E 6.2 ppb Director reported, all outlets in exceedance were not used for food preparation or drinking water. Since testing results, the faucets were replaced, all staff have been informed not to use the faucets for drinking water or food preparation and signs were posted by the outlets reminding others they are for hand washing only. Food preparations is conducted with filtered water and drinking water is provided by a filtered water bottle refilling station. See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative Josefina Fennessey. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023 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: SCHOOL OF THE MADELEINE PRESCHOOL FACILITY NUMBER: 370806443 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/10/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/10/2023 Section Cited CCR 101700.3(b)(1) 1 2 3 4 5 6 7101700.3(b)(1) Written Directives per AB2370: 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 visit. Director reported, all faucets in exceedance were replaced and flushed 4 times a day for 3 weeks before having them tested again on 1/31/23. All staff were informed, and signs were posted not to use the faucets for drinking water or food preparation until retesting is completed and results show the outlets are no longer at or above exceedance level. 8 9 10 11 12 13 14Based on water testing results, facility tested over the Action Level Exceedance at 2 adult sinks not used for food preparation or drinking. This poses a 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:Renesha Askew LICENSING EVALUATOR NAME:Patrick Ma LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2023

Type B citation - potential risk if not corrected