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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006258
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:30:39 AM


Document Has Been Signed on 09/08/2022 11:30 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:BELMONT SHORE CHILDREN'S CENTERFACILITY NUMBER:
198006258
ADMINISTRATOR:ANNA MARTINEZFACILITY TYPE:
850
ADDRESS:30 S. TERMINOTELEPHONE:
(562) 439-3369
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:70CENSUS: 26DATE:
09/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Dora Paredes- Facility RepresentativeTIME COMPLETED:
11:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced case management inspection on 9/8/2022. LPA Navarro arrived at the facility at 9:49am and met with Lead Teacher Dora Parades, who guided LPA on a tour of the facility. There was 26 children and three staff present during the inspection.

The purpose of today's inspection was to go over the water lead test results received on 07/25/2022. Results show that two water sources had action level exceedance of lead. The water fountain located near the play area had a lead result of 20 and the sink faucet near room 3 bathroom (K) had a lead result of 5.8. LPA Navarro observed that both faucets were covered with bags and tape to make them inaccessible to children. The water fountain located in the outside play area has been shut off by having the valve closed. LPA Navarro spoke with the Director who stated that the children bring their own lunch and water from home in their personal drinking container. If children forget to bring water from home, they are provided with a bottled water. Facility also has water delivered and LPA Navarro observed a water cooler. LPA Navarro took pictures of the water faucet and water fountain during the inspection. A deficiency was cited to ensure that the water faucets noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were 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.

Exit interview conducted and report was reviewed with the Facility Representative Dora Paredes. 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: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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 09/08/2022 11:30 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: BELMONT SHORE CHILDREN'S CENTER
FACILITY NUMBER: 198006258

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited

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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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This requirement was not met as evidence by record review. Lead test results showed that two water sources had an action level exceedence. LPA Navarro observed the water faucets to be made inaccessible with plastic bags and tape. The water fountain located outside was also turned off.
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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 ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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