ST. ANDREW'S BY THE SEA 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 12/14/22 at 10:15 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Case Management inspection, for reported Lead Exceedance. LPA Mangina met with Director, Heather Gasner. Also present in the facility were 43 daycare children and 10 teachers/staff in 6 classrooms. Facility was within ratio & capacity. vLPA interviewed staff and examined the faucets and drinking fountains deemed an Action Level Exceedance. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on 12/12/22. Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows: Water Fountain “B” 11 ppb Director reported, the water fountain in exceedance was removed on 12/13/22 and will not be replaced. Prior to replacement, the fountains was masked and bagged. All staff were informed not to use the affected fountain for drinking water or food preparation. Director states that the fountain has not been used since the beginning of covid March 2020. Children bring filled water bottles from home which are refilled using filtered water provided by an outside water company. (continued on LIC809 page 2) SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022 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 3 FACILITY NAME: ST. ANDREW'S BY THE SEA PRESCHOOLFACILITY NUMBER: 372000550 VISIT DATE: 12/14/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32LIC809 page 2) See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative, Heather Gasner. A copy of PIN 21-21-CCP will be provided by email. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022 FACILITY NAME: ST. ANDREW'S BY THE SEA PRESCHOOL FACILITY NUMBER: 372000550 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 12/14/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/11/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Written 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 7Facility Representative states water fountain was removed 12/13/22. 8 9 10 11 12 13 14Based on water testing results and interviews, facility tested over the Action Level Exceedance level at 1 water fountain (B) located outside Starfish Classroom. This posed 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:Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022

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 12/14/22 at 10:15 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Case Management inspection, for reported Lead Exceedance. LPA Mangina met with Director, Heather Gasner. Also present in the facility were 43 daycare children and 10 teachers/staff in 6 classrooms. Facility was within ratio & capacity. vLPA interviewed staff and examined the faucets and drinking fountains deemed an Action Level Exceedance. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on 12/12/22. Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows: Water Fountain “B” 11 ppb Director reported, the water fountain in exceedance was removed on 12/13/22 and will not be replaced. Prior to replacement, the fountains was masked and bagged. All staff were informed not to use the affected fountain for drinking water or food preparation. Director states that the fountain has not been used since the beginning of covid March 2020. Children bring filled water bottles from home which are refilled using filtered water provided by an outside water company. (continued on LIC809 page 2) SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022 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 3 FACILITY NAME: ST. ANDREW'S BY THE SEA PRESCHOOLFACILITY NUMBER: 372000550 VISIT DATE: 12/14/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32LIC809 page 2) See LIC809D for deficiency cited. Exit interview conducted and report was reviewed with the facility representative, Heather Gasner. A copy of PIN 21-21-CCP will be provided by email. A notice of site visit was given and must remain posted for 30 days. SUPERVISORS NAME: Renesha Askew LICENSING EVALUATOR NAME: Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022 FACILITY NAME: ST. ANDREW'S BY THE SEA PRESCHOOL FACILITY NUMBER: 372000550 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 12/14/2022 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 01/11/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Written 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 7Facility Representative states water fountain was removed 12/13/22. 8 9 10 11 12 13 14Based on water testing results and interviews, facility tested over the Action Level Exceedance level at 1 water fountain (B) located outside Starfish Classroom. This posed 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:Adrian L Mangina LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022

Type B citation - potential risk if not corrected