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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500256
Report Date: 02/22/2024
Date Signed: 02/22/2024 12:12:13 PM


Document Has Been Signed on 02/22/2024 12:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WILLIAMS HEAD STARTFACILITY NUMBER:
191500256
ADMINISTRATOR:ROSA GUERRAFACILITY TYPE:
850
ADDRESS:2444 N. DEL MAR AVE.TELEPHONE:
(626) 307-3400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:188CENSUS: 141DATE:
02/22/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Sandra Tarni, EEC ManagerTIME COMPLETED:
12:30 PM
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On February 22, 2024 Licensing Program Analysts (LPAs) Monique Ayala and Jessica Hopkins-Hernandez conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPAs met with EEC Manager Sandra Trani, during the visit. Also present in the facility were 141 day care children and 16 teachers/staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility.

Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs 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.

Facility will provide facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA via email by close of business (COB) 02/22/2024.

On 03/26/2022, the facility was tested for lead exceedances but was not uploaded into the departments water lead database.

(SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 03/26/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

14N – Sink Faucet In Classroom Kitchen (24 UG/L) – Faucet currently not in use.

EEC Manager stated the faucet has not been use prior to the testing and is still not in use. The faucet was retested on 11/09/2022 and was cleared of any lead exceedances.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAMS HEAD START
FACILITY NUMBER: 191500256
VISIT DATE: 02/22/2024
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Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit

https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

A Type B deficiency is being cited under California Code of Regulations Title 22, 101700(b)(1), see LIC809D.

Exit interview conducted and report was reviewed with the facility representative, EEC Manager Sandra Trani. Appeal rights were provided to facility today. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/22/2024 12:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: WILLIAMS HEAD START
FACILITY NUMBER: 191500256

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2024
Section Cited
CCR
101700(b)(1)

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California Lead Action Level at Child Care Centers: Testing results
with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:
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The facility has replaced the faucet outlet and has retested the faucet. The new lead test results show that the faucet no longer has lead exceedances.
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Based on record review, the licensee did not comply with the directive above, as one outlet (outlet used for food preparation) out of thirty-seven outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to children in care.
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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