ST. STEPHEN 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 November 13, 2023, Licensing Program Analysts (LPA)Tso met with director, Kerry O'Shaughnessy. The purpose of inspection was explained and was for an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA was given a tour of the facility. Present in the facility was 2 staff supervising 6 children. LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the site director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. The facility received the ALE report from the Vendor on December 20, 2022, and April 15, 2023. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The affected fixture is, fixture E (5.6 and 5.7 respectively) The affected fixture E were retested on June 1, 2023, with a reading of < 1ppb. Per the updated guidance on written directives in PIN 21-21.1-CCP, facility will be cited for the actionable level exceedance of the fixtures. LPA obtained copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), have been sent to the department by email. * See next page for deficiencies cited today This report was reviewed and signed by Director, Kerry O’Shaughnessy. This notice of Site visit was provided to the licensee and must remain posted for 30 days. SUPERVISORS NAME: Ali Zebila LICENSING EVALUATOR NAME: Man Tso LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023 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. STEPHEN PRESCHOOL FACILITY NUMBER: 384004245 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/27/2023 Section Cited CCR 101700.3 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: 1 2 3 4 5 6 7The facility retested the affected fixture on 6/1/23. It reads < 1 ppb, which is lowered than the Action Level Exceedance. Deficiency has been cleared. 8 9 10 11 12 13 14Based on results received from the certified water samplers, the facility exceeded 5.4 ppb of lead in their water source. This poses a potential 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:Ali Zebila LICENSING EVALUATOR NAME:Man Tso LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023

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 November 13, 2023, Licensing Program Analysts (LPA)Tso met with director, Kerry O'Shaughnessy. The purpose of inspection was explained and was for an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA was given a tour of the facility. Present in the facility was 2 staff supervising 6 children. LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the site director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. The facility received the ALE report from the Vendor on December 20, 2022, and April 15, 2023. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The affected fixture is, fixture E (5.6 and 5.7 respectively) The affected fixture E were retested on June 1, 2023, with a reading of < 1ppb. Per the updated guidance on written directives in PIN 21-21.1-CCP, facility will be cited for the actionable level exceedance of the fixtures. LPA obtained copies of the External Water Sampler Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999), have been sent to the department by email. * See next page for deficiencies cited today This report was reviewed and signed by Director, Kerry O’Shaughnessy. This notice of Site visit was provided to the licensee and must remain posted for 30 days. SUPERVISORS NAME: Ali Zebila LICENSING EVALUATOR NAME: Man Tso LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023 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. STEPHEN PRESCHOOL FACILITY NUMBER: 384004245 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/13/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 11/27/2023 Section Cited CCR 101700.3 1 2 3 4 5 6 7101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: 1 2 3 4 5 6 7The facility retested the affected fixture on 6/1/23. It reads < 1 ppb, which is lowered than the Action Level Exceedance. Deficiency has been cleared. 8 9 10 11 12 13 14Based on results received from the certified water samplers, the facility exceeded 5.4 ppb of lead in their water source. This poses a potential 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:Ali Zebila LICENSING EVALUATOR NAME:Man Tso LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023

Type B citation - potential risk if not corrected