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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016601
Report Date: 08/10/2023
Date Signed: 08/10/2023 10:20:30 AM


Document Has Been Signed on 08/10/2023 10:20 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:BUFFUM HEAD STARTFACILITY NUMBER:
198016601
ADMINISTRATOR:RUTH CABRALFACILITY TYPE:
850
ADDRESS:2350 XIMENO AVENUETELEPHONE:
(562) 498-7058
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:40CENSUS: 0DATE:
08/10/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Amanda Kanbar, Early Learning Center Manager (ELCM)TIME COMPLETED:
10:45 AM
NARRATIVE
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On 08/10/2023 at 9:50 AM, Licensing Program Analysts (LPA) Katrina Chicote and Raul Navarro conducted an Unannounced Case Management Inspection and met with Keokuk Legarde (ELCM) and Amanda Kanbar (ELCM). LPAs disclosed the purpose of the inspection and was granted entry into the facility. Facility is made up of two classrooms K-1 (AM Program) and K-2 (Full Day Program) located on Buffum Elementary School campus.

There were no children present during today's inspection due to program still not operating for Summer Break.

The purpose of today's inspection was to discuss the water lead test results. Results show that the drinking fountains (labeled E and G) in the outdoor play area has action level exceedance (ALE) of lead: E drinking fountain result of 20.7 ppb and drinking fountain G result of 15.0 ppb.

At 9:54 AM. LPA observed and took pictures of the water sources with ALE. LPA observed drinking fountains to be turned off at time of inspection. Per ELCM, water is being remediated and will be retested and in the mean time children will be provided water bottles for drinking water in the outdoor play area. Per ELCM, parents will be notified pending a letter distributed by LBUSD. Per ELCM, no meals are prepared on site and all meals are delivered by Head Start Kitchen.

A deficiency was cited to ensure that the water sources with the exceedances will not be used as a drinking source or food preparation source for the children.

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

Exit interview was conducted and report was reviewed with Facility Representatives.

Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
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 08/10/2023 10:20 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: BUFFUM HEAD START
FACILITY NUMBER: 198016601

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb 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... Action Level Exceedance. This requirement was not met as evidence by:
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LPAs observed water sources to be turned off at time of inspection. Per ELCM, children will be provided water bottles until water is remediated and retested. Results of retesting will be provided to LPA by POC date.
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Based on record review the Licensee did not ensure water sources at facility to meet lead requirements. Lead test results showed that two water sources have an action level exceedance. This poses a potential health, safety, and personal rights 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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2