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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870959
Report Date: 11/22/2022
Date Signed: 11/22/2022 12:30:15 PM

Document Has Been Signed on 11/22/2022 12:30 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:PLAZA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191870959
ADMINISTRATOR:CIRENIA BARRERAFACILITY TYPE:
850
ADDRESS:648 SOUTH INDIANATELEPHONE:
(323) 268-9640
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY: 110TOTAL ENROLLED CHILDREN: 110CENSUS: 39DATE:
11/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Rosalba Bravo/Denisse CalderonTIME COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection on 11/22/2022. LPA Birks met with Director Rosalba Bravo and Site Supervisor Denisse Calderon who guided LPA on a tour of the facility. There were 39 preschool children and nine staff present during the inspection.

The purpose of today's inspection is to review and discuss the October 06, 2022 water lead test results received on November 3, 2022. Results indicate that one water source had an action level exceedance of lead. One of two faucets in the kitchen had a final lead result of 23. LPA Birks observed the faucet and sink fixture was sealed off to prevent use. Site Supervisor Denisse Calderon indicated that the facility is only using the faucet and sink closest to the door which does not have a lead exceedance.

At approximately 11:00am LPA Birks took a picture of the sealed off water fixture during the inspection. LPA also contacted the water testing company to verify that only one kitchen faucet had the lead exceedance.
A deficiency was cited to ensure that the water faucet noted will not be used as a drinking source unless the plumbing fixture passes future water testing. The deficiency listed was observed to be a potential risk and is being cited in accordance with California Code of Regulations Title 22.

Note: Site Supervisor Calderon provided LPA with a signed plan of correction indicating the following: A certified plumber will be contacted for the repair and water will be flushed for three weeks after installation. Once a passing retest is completed, LPA will send a letter closing out the deficiency.

Exit interview conducted and report was reviewed with the Site Supervisor Denisse Calderon. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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 11/22/2022 12:30 PM - It Cannot Be Edited


Created By: Warren Birks On 11/22/2022 at 11:21 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: PLAZA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870959

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2022
Section Cited
CCR
1017003b1

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(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 Exceedence
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Site Supervisor Denisse Calderon provided LPA with a signed plan of correction indicating the following: A certified plumber will be contacted for the repair and water will be flushed for three weeks after installation. A passing retest will be submitted.
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This requirement was not met as evidence by record review. Lead test results revealed one water source had an action level exceedence. 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:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022


LIC809 (FAS) - (06/04)
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