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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601006
Report Date: 04/19/2023
Date Signed: 04/19/2023 03:55:25 PM


Document Has Been Signed on 04/19/2023 03:55 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:M A W CHILDREN'S CTRFACILITY NUMBER:
191601006
ADMINISTRATOR:SHELIA PALMERFACILITY TYPE:
850
ADDRESS:5510 CLARK AVETELEPHONE:
(562) 867-4083
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:56CENSUS: 42DATE:
04/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Director Sheila Palmer TIME COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced case management inspection on 04/19/2023. LPA met with Director Sheila Palmer who guided LPA on a tour of the facility. LPA observed 12 children and one staff in room 4 and a total of 30 children with 4 staff from Room 2 and Room 3 who were playing outside.

The purpose of today's inspection was to review the water lead test results received on 03/29/2023. Results show that one water source had an action level exceedence of lead. The hand washing sink located in room 4 had a lead exceedence of 6.6 ppb. Per Director, the sink is not used for drinking water or food preparation. It is only used for hand washing. LPA observed the Director make the sink inaccessible during today's visit. The Director taped plastic bags around the sink and placed a sign stating "out of order-do not use". LPA observed Director inform staff that sink cannot be used.
Children use the drinking fountains located throughout the facility. The drinking fountains did not have an action level exceedance of lead. LPA took pictures of the sink during the inspection. A deficiency was cited to ensure that the sink noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page was 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.

Exit interview conducted and report was reviewed with Director Sheila Palmer . A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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 04/19/2023 03:55 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited

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101700.3(b)(1)Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, 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 was not met as evidence by:
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Per Director, the water source is not used for drinking or food preparation. Per Director, a work order will be submitted to either close the water source or replace the water source. LPA advised if water source is replaced, it will need to be re-tested. Director will provide proof of completed work order by POC due date.
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Based on record review the licensee did not ensure water source at facility meet lead requirements. Lead test results showed that one hand washing sink had an action level exceedance. The water source has been made inaccessible. This poses a potential Health, Safety or Personal Rights 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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
LIC809 (FAS) - (06/04)
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