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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005602
Report Date: 11/09/2023
Date Signed: 11/09/2023 11:45:39 AM


Document Has Been Signed on 11/09/2023 11:45 AM - 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:LAKESHORE KIDS & COMPANYFACILITY NUMBER:
198005602
ADMINISTRATOR:ROSA SANCHEZFACILITY TYPE:
830
ADDRESS:2695 E. DOMINGUEZ ST.TELEPHONE:
(310) 537-8600
CITY:CARSONSTATE: CAZIP CODE:
90895
CAPACITY:14CENSUS: 3DATE:
11/09/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Director Rosa SanchezTIME COMPLETED:
11:50 AM
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
Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced case management inspection on 11/09/2023. LPA Navarro arrived at the facility at 11:22 am and met with Facility Representative Rosa Sanchez who guided LPA on a tour of the facility. There were 3 children and four staff present during the inspection.

The purpose of today's inspection was to follow up on the lead exceedence found for the drinking faucet located in the yellow room. The water fountain had a lead exceedence of 9.490 ppb on 11/29/2022. Per FR, the faucet had a bag and tape over the faucet to make it inaccessible to the children in care and staff. Per FR, the facility had that faucet retested in February 3, 2023 after flushing it. Results came back showing faucet had an action level less than 1.00 ppb. A deficiency was cited for the original test date of the faucet showing that there was a lead exceedence. The deficiency has been cleared as the faucet was retested and has no lead exceedence.

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 has been cleared to protect the children’s health & safety.

Exit interview conducted and report was reviewed with Facility Representative Rosa Sanchez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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 2


Document Has Been Signed on 11/09/2023 11:45 AM - 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: LAKESHORE KIDS & COMPANY
FACILITY NUMBER: 198005602

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2023
Section Cited
CCR
101700.3(b)(1)

1
2
3
4
5
6
7
(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 This requirement was not met as evidenced by
1
2
3
4
5
6
7
The facility flushed the water faucet and had it retested on February 2, 2023. The resutls from the test shows that the water faucet has an action level of less than 1.00.ppb. LPA obtained a copy of the test report. The defiency was cleared during inspection.
8
9
10
11
12
13
14
record review. Lead test results showed that one water source had an action level exceedence of 9.490 ppb. This is a potential risk to the health and safety of the children in care. The water source is located in the yellow room. Water source was covered with a bag and tape before the retest to make it
8
9
10
11
12
13
14
 inacessible to the children in care and staff.

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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2