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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600391
Report Date: 05/03/2024
Date Signed: 05/03/2024 11:01:17 AM

Document Has Been Signed on 05/03/2024 11:01 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GRACE FIRST PRESBYTERIAN CHURCH PRESCHOOLFACILITY NUMBER:
191600391
ADMINISTRATOR/
DIRECTOR:		STEPHANIE DANIELSFACILITY TYPE:
850
ADDRESS:3955 STUDEBAKER ROADTELEPHONE:
(562) 425-0080
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 34DATE:
05/03/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director, Nicole IslasTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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On May 3, 2024, at 9:30 AM, Licensing Program Analysts (LPAs) A. Wallin and S. Sanchez conducted an unannounced case management inspection and was met with director, Nicole Islas, who provided assistance. LPA toured the facility and a census was taken. LPA observed today's census was 9 staff and 34 children.

The purpose of today's inspection was to go over the water lead test results discovered on 3/5/2024. Results show that one classroom faucet and reception office water faucet, sample site F, source had action level exceedance of lead. Per review of State Child Care Center Lead Sampling and Reporting Tool, Sample site F, had a lead result of 5.4 ppb. Per PIN 21-21.1-CCP, Section 101700(b) of the Written Directives has been amended to clarify that the action level of 5.5 ppb is a health and safety standard with which CCC licensees must comply. Thus, Sample site F is in compliance with Title 22 regulations.

The water fountain, sample site C, located in the four-year-olds butterfly room had a lead result of 8.4 ppb. Per director, facility temporary fix for the water faucet source was to shut it off. Photo evidence provided of the water faucet source covered with a bag and the water valve being turned off. During inspection, LPAs observed facility covered water faucet source with plastic bag, water fountain spout attached to sink taped over with painters tape and water faucet valve is shut off. LPA discussed with director regarding permanent solutions for lead exceedance. Per director, she will connect with church office and plumbing contractor to make a permanent solution. Per director, facility provides drinking water from Arrowhead water jugs and or use water from filtered water system located in the teachers’ lounge. Per director, sample site C is not being used for drinking or consumption purposes. During visit, LPAs collected documentation of water usage at facility. A deficiency was cited to ensure that the water faucet noted will not be used as a drinking source or food preparation source for the children.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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
Document Has Been Signed on 05/03/2024 11:01 AM - It Cannot Be Edited


Created By: Angelica Wallin On 05/03/2024 at 10:34 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: GRACE FIRST PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 191600391

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
Section Cited
CCR
101700.3(b)(1)-(b)

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Result with values of 5.0 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 one water source had an action level exceedance.
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During facility visit, LPAs collected the plan of correction (POC) to permanently disabled the water faucet and water fountain sources. Director to submit pictures of permanently disable water sources with lead exceedance via email.
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LPA observed water faucet source covered with plastic bag, water fountain spout attached to sink taped over with painters tape and water faucet valve is shut off. 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:Karen Chambers
LICENSING EVALUATOR NAME:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE FIRST PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 191600391
VISIT DATE: 05/03/2024
NARRATIVE
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The deficiency listed on the following page were observed by LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. During facility visit, LPAs collected the plan of correction (POC) to permanently disabled the water fountain.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with director, Nicole Islas.


PAGE 2 OF 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3