<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870952
Report Date: 12/15/2022
Date Signed: 12/15/2022 02:34:35 PM


Document Has Been Signed on 12/15/2022 02:34 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:STATE STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870952
ADMINISTRATOR:KANDIS HAMBLETFACILITY TYPE:
850
ADDRESS:3210 BROADWAYTELEPHONE:
(323) 589-3718
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:86CENSUS: 39DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Oscar Acajabon, Office ManagerTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On December 15, 2022, at 1:50 p.m., Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection and met with Office Manager, Oscar Acajabon. LPA disclosed the purpose of the inspection and was granted entry into the facility by Office Manager..

There were 39 children and 12 staff present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that one water source has action level exceedance (ALE) of lead. The drinking fountain located outside Classroom E has a lead exceedance of 7.2 Points Per Billion (ppb).

At 2:00 p.m. LPA observed and tested of the water source with ALE. Water source was observed to be inaccessible to children. The drinking fountains are roped off with caution tape. Water source with ALE does not impact children's access to water. Water fountains in the classrooms are operable, Room C provides a pitcher of water and cups for child and there is an alternate water fountain outside accessible to children. LAUSD Lead exceedance team has begun to correct the ALE and is in the process of installing filters to the affected water sourced. LAUSD facility maintenance has not given a date to begin work. Lead results are posted in the main entrance visible to parents. A deficiency was cited to ensure that the water sources with the exceedance will not be used as a drinking source or food preparation source for the children.

All meals are prepackaged and delivered daily by Los Angeles Unified School District (LAUSD). Food is not cook or prepared at the facility.

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. ----------------------PAGE
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
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 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: STATE STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870952
VISIT DATE: 12/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and Plans of Corrections were reviewed and developed with Principal. A copy of this report and appeal rights were discussed and left with Office Manager, Oscar Acajabon, whose signature on this form confirm receipt of these documents.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
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
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 12/15/2022 02:34 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: STATE STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870952

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2023
Section Cited

1
2
3
4
5
6
7
101700.3(b)(1)
(b) 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:
1
2
3
4
5
6
7
Water source showing ALE has been roped off and children do not have access. Per lead exceedance team, facility maintenance will be adding filters to the water sources in order to correct the lead exceedance. Maintenance date is still being determined. Principal or Lead Exceedance team will send LPA an email confirming correction by POC date 1/6/23.
8
9
10
11
12
13
14
Based on record review the licensee did not ensure water source at facility meet lead requirements. Lead test results showed that one drinking water sources has an action level exceedance. LPA observed water source is inaccessible to children. This poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Denise GibbsTELEPHONE: (323) 558-2794
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)
Page: 3 of 3