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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593518
Report Date: 09/13/2023
Date Signed: 09/13/2023 02:37:23 PM


Document Has Been Signed on 09/13/2023 02:37 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:OPTIONS HEAD START - SHIVELYFACILITY NUMBER:
191593518
ADMINISTRATOR:DIANE HERNANDEZFACILITY TYPE:
850
ADDRESS:1431 N. CENTRAL AVENUETELEPHONE:
(626) 459-3085
CITY:SOUTH EL MONTESTATE: CAZIP CODE:
91733
CAPACITY:23CENSUS: 0DATE:
09/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Araceli Miranda, Teacher TIME COMPLETED:
02:45 PM
NARRATIVE
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On 9/13/2023, at 1:30 PM, Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with Teacher Araceli Miranda, during the visit. There was no children present on this date since facility had no power. 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 provided facility sketch and required forms LIC 9276, LIC 999 and LIC9275 to the department.

On 7/5/2023, 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 6/10/2023 . Sink Faucets reported with 5.5 ppb or greater lead exceedance levels were as follows

 C- Left side drinking water fountain in room # 1 (7.4 UG/L)

LPA Lopez has been in contact with Facilities Administrator Andrea Butler who informed LPA that bubbler was replaced and had been re-tested on 7/29/2023, pending results.-- pg. 1 of 2-----------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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 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: OPTIONS HEAD START - SHIVELY
FACILITY NUMBER: 191593518
VISIT DATE: 09/13/2023
NARRATIVE
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LPA observed the water fountain to be uncovered- per Teacher Araceli Miranda, they were not aware of lead testing. LPA advised that water fountain has to be covered and made inaccessible for children in care. Fountain was covered with a taped bag around it during inspection- LPA took pictures before and after. Per teacher all children bring their own water bottles.

See LIC809D for Type B deficiency cited. LPA did clear deficiency on this date and will provide facility representative with a copy of clearance on this date

Appeal rights were provided to facility today. A notice of site visit was also provided and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Teacher Araceli Miranda.
----------------------------------------------------------pg.2 of 2 -------------------------------------------------------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/13/2023 02:37 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: OPTIONS HEAD START - SHIVELY
FACILITY NUMBER: 191593518

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1)California Lead Action Level at Child Care Centers. (b) 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 me at evidenced by
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Per Facilities representative the bubbler has been replaced and retested on 7/29/2023, pending results. Water fountain will remain covered and off limits for children until passing results are received.
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Based on ispection, the licensee did not comply with the directive above, as sample site C left water fountain in rm. # 1 tested with an Action Level Exceedance (ALE) of 7.4 ppb. This poses a potential 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3