191501766-2-1-2023-33-CC-NTCG-CNMVGZ-20230201152623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191501766
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:26:40 PM

Document Has Been Signed on 02/01/2023 03:26 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:	GOOD SHEPHERD CHILDREN'S CENTER, THE		FACILITY NUMBER:	191501766
ADMINISTRATOR:	BROWN, LINDA		FACILITY TYPE:	850
ADDRESS:	400 W. DUARTE ROAD		TELEPHONE:	(626) 447-1249
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	56	CENSUS: 42	DATE:	02/01/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Linda Brown - Director		TIME COMPLETED:	01:05 PM

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

Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. Upon Arrival at 11:10 AM, LPA met with Director Linda Brown, who guided LPA on a tour of the facility. There were children present during the time of the inspection.

Census was taken. LPA observed 42 children with 8 staff members.

LPA 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 provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA during today’s inspection.

On 12/17/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 12/17/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

G30 - "Outside Drinking fountain" - Tested with a result of 7.900 ppb

Director states that the fountain has not been used since before the COVID pandemic. They have had children bring their own water bottle for the last 3 years and have had large Arrowhead 10 gallon bottles to help refill the bottles for them if empty. LPA observed a sign stating not to use the fountain. Staff turned the handle for the LPA and observed that the water has been shut off from the outlet. LPA observed water bottles in each classroom for the children. REPORT CONTINUES PAGE 1 of 2

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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 3

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: GOOD SHEPHERD CHILDREN'S CENTER, THE	FACILITY NUMBER: 191501766
	VISIT DATE: 02/01/2023

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
32

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

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Notice of Site Visit was provided and must remain post for 30 consecutive days. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

An exit interview conducted with Director Linda Brown, 12:55pm, and a copy of this report was provided.

END OF REPORT PAGE 2 of 2

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/01/2023 03:26 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: GOOD SHEPHERD CHILDREN'S CENTER, THE	FACILITY NUMBER: 191501766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/08/2023 Section Cited	1 2 3 4 5 6 7	101700.3 (b)(1) Testing results with fractional ppb readings of 5.5 ppb or greater shall be rounded up to the nearest whole number...(1) A result with values of 5.5 or greater shall be deemed and Action Level Exceedance This requirement was not met as evidence by:	1 2 3 4 5 6 7	Per Director, the water is shut off from the outlet, there is sign on the outlet noting Out of Service, and the children currently bring their own water bottles. Bottles are refilled using Arrowhead water dispensers. Director will submit written plan and arrowhead invoice submitted to LPA by POC.
	8 9 10 11 12 13 14	Based on record review and interview, test results showed 1 water outlet in the facility playground. This is a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3