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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601818
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:10:37 PM


Document Has Been Signed on 12/15/2022 03:10 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:DOROTHY AHRENS NURSERY SCHOOLFACILITY NUMBER:
191601818
ADMINISTRATOR:AHRENS-SALLEY,NANCYFACILITY TYPE:
850
ADDRESS:4960 LONG BEACH BLVDTELEPHONE:
(562) 423-3880
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:63CENSUS: 34DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Director - Nancy Ahrens-SalleyTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management inspection on 09/08/22. LPA R. Derraco arrived at the facility at 01:15 PM and met with Director Nancy Ahrens-Salley, who guided LPA on a tour of the facility. There was 34 children and 4 staff present during the inspection.

The purpose of today's inspection was to go over the water lead test results received on 11/30/22. Results show that one water source had action level exceedance of lead. The water fountain located in Room #2 located next to the entrance had a lead result of 6.6. LPA R. Derraco observed that the water fountain was covered in tape to make it inaccessible to children. Director states that she has hired a plumber to have the water fountain turned off. Director also states that children in care use sippy cups that are filled with water from the kitchen faucet. Per review of lead testing result report, kitchen faucet used as a source for water has a "Non Detection" or "ND" result. LPA took pictures of the drinking fountain during the inspection. A deficiency was cited to ensure that the water fountain 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 the Director Nancy Ahrens-Salley. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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 2


Document Has Been Signed on 12/15/2022 03:10 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: DOROTHY AHRENS NURSERY SCHOOL
FACILITY NUMBER: 191601818

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/04/2023
Section Cited

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(b) Testing results with fractional ppb reading of .5 ppb or greaetr 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
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The facility will provide a written statement on their plan to continue to ensure that the water source will not be used as a drinking or food source by POC date 01/04/23
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This requirement was not met as evidence by the record review. Lead test results showed that one water source had an action level exceedance. LPA R. Derraco observed the water fountain to be made inaccessible with tape.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
LIC809 (FAS) - (06/04)
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