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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015307
Report Date: 05/18/2023
Date Signed: 05/18/2023 03:16:11 PM


Document Has Been Signed on 05/18/2023 03:16 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:COLONIAL HOUSE PRESCHOOLFACILITY NUMBER:
198015307
ADMINISTRATOR:JOANNA HAWKINSFACILITY TYPE:
850
ADDRESS:1124 MISSION STREETTELEPHONE:
(626) 403-6554
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:60CENSUS: 26DATE:
05/18/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rita Pettit, Lead TeacherTIME COMPLETED:
03:35 PM
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On 05/18/2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with lead teacher, Rita Pettit, during the visit. Also present in the facility were 26 day care children and 4 teachers/staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility. Licensee, Will Hawkins called LPA shortly after arrival to discussion inspection.

Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

Facility provided facility sketch and required forms LIC999 and LIC9275 to LPA via email on 05/16/2023. Per licensee, the LIC9276 will be forwarded to LPA once Licensee has completed form.

On 04/28/2023, the Department received notification from the State Water Resources Control Board

(SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 04/28/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

A – Sink Faucet In Office Restroom (Second Floor) (14.4 UG/L) – Faucet is inaccessible to children in care

F - Sink Faucet In Main Area (First Floor) (12.5 UG/L) - Faucet is only used for hand washing.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: COLONIAL HOUSE PRESCHOOL
FACILITY NUMBER: 198015307
VISIT DATE: 05/18/2023
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Licensee stated that one of the faucets is inaccessible to children in care and the other faucet is only used for children to wash their hands.

Per Licensee, the faucets are not used for consumption nor for food preparation. Per licensee the facility only provides dry snacks and children bring their own lunch and waters. Per licensee, if the children need more water the facility provides the children with filtered water. The faucet’s use was terminated when the facility was informed by analyst that it was exceeding acceptable levels. Per licensee, he stated that the faucet downstairs has been fixed. Per licensee, he will find another lead company to retest the water or file for an exception through the department due to not using the water faucets for consumption or food preparation.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit

https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

See LIC809D for Type B deficiency cited.

Exit interview conducted and report was reviewed with the Lead Teacher Rita Pettit. A copy of PIN 21-21-CCP and appeal rights were provided to facility today. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/18/2023 03:16 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: COLONIAL HOUSE PRESCHOOL
FACILITY NUMBER: 198015307

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/30/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., 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 is not met as evidenced by:
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Licensee stated that he will find another lead company to retest the outlets and file for an exceptions through the department since the outlets are not used to food preparation or consuption.
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Based on record review, the licensee did not comply with the directive above, as two outlet (outlet used for hand washing only) out of nine outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to 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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
LIC809 (FAS) - (06/04)
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