198015613-5-1-2023-33-CC-RLOZ-CREKU3-20230501081204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015613
Report Date: 04/28/2023
Date Signed: 05/01/2023 08:12:31 AM

Document Has Been Signed on 05/01/2023 08:12 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	EL MONTE CITY S.D.-POTRERO SCHOOL HEAD START		FACILITY NUMBER:	198015613
ADMINISTRATOR:	LISA DUNBAR		FACILITY TYPE:	850
ADDRESS:	2611 N. POTRERO AVENUE		TELEPHONE:	(626) 453-3700
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91733
CAPACITY:	20	CENSUS: 12	DATE:	04/28/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Site Supervisor Guillermina Diaz		TIME COMPLETED:	01:45 PM

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	On 04/28/2023, at 11:25 AM, Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with Site Supervisor, Guillermina Diaz, during the visit. Also present in the facility were 12 day care children and 3 teachers/staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility. 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 LIC 9276, LIC999 and LIC9275 to LPA on 12/19/2023 and on 3/17/23. Results submitted on 12/19/2023 do not match results on the State Water Resources Control Board Division of Drinking Water Website. Per Site Supervisor the samples that had exceedence levels were 33-B, 33-C, 33-D, 33-E and 33F. On 3/15/2023, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). These results were results to the retest. The SWRCB report indicated the facility was inspected and samples were collected on 3/9/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows: -------------------------------------------- ----------------- pg.1 of 2------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EL MONTE CITY S.D.-POTRERO SCHOOL HEAD START	FACILITY NUMBER: 198015613
	VISIT DATE: 04/28/2023

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
26
27
28
29
30
31
32

-F30 – Sink Faucet (14.000 UG/L) – LPA observed that there is no F30 on site- Per documentation received on 12/19/2023 no F30 was tested.
- F- Sink Faucet (13.000 UG/L)- Faucet currently not in use- has been capped permanently
- E30- Sink Faucet (6.000 UG/L)- .LPA observed that there is no E30- Per documentation received on 12/19/2023 no E30 was tested.

All faucet use was terminated when the facility was informed by analyst that it was exceeding acceptable levels.

Results received on 3/15/2023 indicate that Sink Faucet F did not passed re-test. Facility has permanently capped this faucet. Faucets 33B and 33E have been replaced and have passed testing. Faucets 33C and 33D have passed the re-test but are permanently capped as children don't use these.

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 visithttps://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information
See LIC809D for Type B deficiency cited.

Per Retest conducted and corrections made LPA cleared deficiency on this date. Plan of Correction Letter was given.

Exit interview conducted and report was reviewed with the facility representative. 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.

-------------------------------------------------------- pg. 2 of 2---------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 05/01/2023 08:12 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: EL MONTE CITY S.D.-POTRERO SCHOOL HEAD START	FACILITY NUMBER: 198015613
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/28/2023 Section Cited	1 2 3 4 5 6 7	101700.3(b)(1) 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 me at evidenced by	1 2 3 4 5 6 7	Per Site Supervisor, Sink Faucet F did not passed re-test. Facility has permanently capped this faucet. Faucets 33B and 33E have been replaced and have passed testing. Faucets 33C and 33D have passed the re-test but are permanently capped as children don't use these.
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the directive above, as five outlets tested with an Action Level Exceedance (ALE). This poses a potential health and safety risk to children in care	8 9 10 11 12 13 14
	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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3