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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570967
Report Date: 01/26/2024
Date Signed: 01/26/2024 10:10:42 AM

Document Has Been Signed on 01/26/2024 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:TRACY INFANT CENTERFACILITY NUMBER:
191570967
ADMINISTRATOR:TOM WOODWARDFACILITY TYPE:
830
ADDRESS:12222 CUESTA DRIVE, BLDG FTELEPHONE:
(562) 229-7762
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 62TOTAL ENROLLED CHILDREN: 17CENSUS: 5DATE:
01/26/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Dr. Rebecca LynchTIME COMPLETED:
10:15 AM
NARRATIVE
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On 1/26/2024, about 8:45AM, Licensing Program Analysts (LPAs) T. Tran and C. Kam conducted an unannounced case management inspection at Tracy Infant Center. Upon arrival, LPA met with Dr. Rebecca Lynch, Supervisor Child Development and Special Program and we toured the facility. LPAs observed proper care and supervision.

The purpose of today's inspection was to go over the water lead test results received on 12/23/23. Results show that two water sources had action level exceedance of lead. The sink located in toddler class had a lead result of 8.68 and the special needs class sink 7.50. LPAs observed that both sinks were not in use and inaccessible to children. Per facility representative, children drinking source is current use by the kitchen sink. A deficiency was cited to ensure that the water faucets noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were observed by the LPAs 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. Plan of correction has been cleared during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Dr. Rebecca Lynch.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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Document Has Been Signed on 01/26/2024 10:10 AM - It Cannot Be Edited


Created By: Tiffanie Tran On 01/26/2024 at 09:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: TRACY INFANT CENTER
FACILITY NUMBER: 191570967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2024
Section Cited
CCR
101700.3(b)(1)

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Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that two water sources had an action level exceedance.
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POC- On 1/26/24, facility had provided a written statement on their plan to continue to ensure that the water sources will not be used as a drinking or food preparation source. Facility provides differnet water source for the children to drink.
POC is cleared during today's visit.
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LPA observed the water sinks to be made inaccessible to children in care. The classroom sinks has been turned off when not in use for secondary lead in water testing. This is a potential risk to the health and safety of the 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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024


LIC809 (FAS) - (06/04)
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