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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003517
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:21:09 PM

Document Has Been Signed on 11/01/2023 04:21 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:OPTIONS-CDC- VILLACORTAFACILITY NUMBER:
198003517
ADMINISTRATOR:ISIS CHIRINOSFACILITY TYPE:
850
ADDRESS:17721 E. GEMINITELEPHONE:
(626) 964-8876
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 48TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
11/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Araceli Navarro/Joel UristaTIME COMPLETED:
04:30 PM
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On 11/1/2023 Licensing Program Analysts (LPAs) Carolyn Tuba and Stephanie Li conducted an unannounced case management inspection. A COVID 19 risk assessment was conducted. LPAs arrived at the facility at 3:05 pm and met with Lead Teacher, Araceli Navarro and Maintenance Lead Tech, Joel Urista. LPAs observed 4 children with 2 staff in care.

The purpose of today's inspection is to go over the water lead test results received on 08/21/2023. Results indicate that fixture “D” drinking fountain water source in Classroom #1 and fixture “F” kitchen faucet water source in Classroom #2 had action level exceedance of lead. The "D" drinking fountain water source located in the preschool classroom #1 had a lead result of 11. The "F" kitchen faucet water source located in the preschool classroom #2 had a lead result of 27. During the visit, the Maintenance Lead Tech had stated that the drinking fountain has been removed and capped off. The kitchen faucet has been replaced but retest has not been conducted per Maintenance Lead Tech. There has been a bag with a sign to not use placed over the kitchen sink in classroom #2. LPAs were informed that classroom #2 does not have any children in care and is being used as storage. LPAs took photos. According to Lead Teacher children are provided water from the kitchen sink in classroom #1 that has been tested and there are no lead exceedances from that water source. LPA, Carolyn Tuba received all documentation, including facility sketch, LIC9276, LIC9275, photos and test results from Andrea Butler, Facilities Administrative Coordinator prior to visit.

A deficiency was cited on attached 809D. The deficiency listed on the following page were observed by the LPAs 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.

A notice of site visit was given to licensee and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Lead Teacher, Araceli Navarro.
Ana Chico
Carolyn Tuba
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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 11/01/2023 04:21 PM - It Cannot Be Edited


Created By: Carolyn Tuba On 11/01/2023 at 03:53 PM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OPTIONS-CDC- VILLACORTA
FACILITY NUMBER: 198003517

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2023
Section Cited

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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... (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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This requirement is not met as evidenced by: Based on testing results provided by the facility with an Action Level Exceedance (ALE) 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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


LIC809 (FAS) - (06/04)
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