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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191801470
Report Date: 02/28/2024
Date Signed: 02/29/2024 01:22:56 PM


Document Has Been Signed on 02/29/2024 01:22 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ORIENTAL MISSION CHURCH NURSERY SCH00LFACILITY NUMBER:
191801470
ADMINISTRATOR:NO, HANNAHFACILITY TYPE:
850
ADDRESS:424 N. WESTERN AVE.TELEPHONE:
(323) 466-8046
CITY:LOS ANGELESSTATE: CAZIP CODE:
90004
CAPACITY:120CENSUS: 10DATE:
02/28/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Eileen KimTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Director Eileen Kim.

During the inspection 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, LIC999 and LIC9275 to LPA

Facility stated they will provided a copy of the facility sketch, LIC 9276, and LIC 9275 to LPA Lee by the POC date since they just received the results from the testing vendor today.

On 02/26/2024, 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 02/16/2024. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

Sample A. Faucet in the located in the kitchen sink (6.0 UG/L) – Fountain currently not in use.
Sample C. A Hose near the stove of the same kitchen (20.0 UG/L)- The hose was never used by the facility and is being used by the church on weekends.

The Director stated that the hose (Sample C) has never been used by the child care center. Since the other Faucet located in the same kitchen (Sample B .58 UG/L) did not have lead exceedance, the Director stated that the facility will only use the kitchen faucet (sample B) and will not use the other faucet (Sample A) until it has been retested.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ORIENTAL MISSION CHURCH NURSERY SCH00L
FACILITY NUMBER: 191801470
VISIT DATE: 02/28/2024
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LPA advised Director that lead testing results must be posted outside for parents to view until the next testing is conducted every 5 years from the date of the initial test. The Director stated that the results will be posted by today since the results were provided by the vendor on this date.

A deficiency was cited on attached LIC809-D. The deficiency listed on the following page were reviewed by the LPA and is being cited in accordance with California Code of Regulations Title 22. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Eileen Kim. Appeal rights discussed and explained.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/29/2024 01:22 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ORIENTAL MISSION CHURCH NURSERY SCH00L
FACILITY NUMBER: 191801470

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2024
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 was not met as
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The Director stated that the faucet in the kitchen will not be used until it has been retested. Since the results from the Vendor was received today by the facility The Director stated that the LIC 9276 and LIC9275 will be provided to the LPA by the POC date.
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evidenced by the fact that a faucet in the kitchen used by the facility (Sample A) was observed to have Action Level Exceedance (ALE) of 6.0, which poses/posed a potential health, safety or personal rights risk to persons 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: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
LIC809 (FAS) - (06/04)
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