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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416599
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:19:36 PM


Document Has Been Signed on 01/11/2023 02:19 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:WALNUT PARK ELEMENTARY SCHOOL LAUPFACILITY NUMBER:
197416599
ADMINISTRATOR:SARAID LUNAFACILITY TYPE:
850
ADDRESS:2642 OLIVE STREET RM.B1 & B2TELEPHONE:
(323) 588-3145
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:42CENSUS: 12DATE:
01/11/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Saraid Luna, PrincipalTIME COMPLETED:
02:30 PM
NARRATIVE
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On January 11, 2023, at 1:30 p.m., Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection and met with Principal Saraid Luna. LPA disclosed the purpose of the inspection and was granted entry into the facility by office staff.

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

The purpose of today's inspection was to discuss the water lead test results. Results show that two water sources have action level exceedance (ALE) of lead. The drinking fountains located inside classrooms B-1 and B-2 have a lead exceedance of 126 points per billion(ppb) and 78 ppb.

At 1:40 p.m. LPA observed and tested the water sources with ALE. Drinking fountains were observed to be turned off and inaccessible to children. Per classroom staff, water is made readily available to children via water bottles provided by the facility. LPA observed water bottles in the classroom and extra water bottles in storage. Lead results are posted at the drop off/pick up gate where they are accessible to parents. LAUSD Lead exceedance team has begun to correct the ALE by shutting off the water, they have installed filters and new faucets. Water has been retested and results are pending. A deficiency was cited to ensure that the water faucets 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 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
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: WALNUT PARK ELEMENTARY SCHOOL LAUP
FACILITY NUMBER: 197416599
VISIT DATE: 01/11/2023
NARRATIVE
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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 Principal, Sarahid Luna, whose signature on this form confirm receipt of these documents.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/11/2023 02:19 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: WALNUT PARK ELEMENTARY SCHOOL LAUP

FACILITY NUMBER: 197416599

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2023
Section Cited

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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:
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Water sources showing ALE has been shut off and children do not have access. facility maintenance added filters and new faucets and retest was conducted on 1/10/23 to correct the lead exceedance. Retest results are pending. Principal or Lead Exceedance team will send LPA an email confirming correction by POC date 1/31/23.
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Based on record review the licensee did not ensure water sources at facility meet lead requirements. Lead test results showed that two water sources have an action level exceedance. LPA observed water source is inaccessible to children.
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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: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3