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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017598
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:55:45 PM


Document Has Been Signed on 09/19/2023 03:55 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PACIFIC CLINICS NESBITT EARLY HEAD STARTFACILITY NUMBER:
198017598
ADMINISTRATOR:LA SHON TILLIE-JONESFACILITY TYPE:
830
ADDRESS:349 W. ALTADENA DR.TELEPHONE:
(626) 794-7192
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:32CENSUS: 13DATE:
09/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:21 PM
MET WITH:Judy CashellTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Case Management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. A COVID 19 risk assessment was conducted prior to entering the facility. LPA met with facility representative Judy Cashell and stated the purpose of the visit. Also present in the facility were 13 infants/toddlers, 7 teachers and 2 assistants. Facility was within ratio & capacity.

LPA 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 representative during the inspection. Per AB 2370, all CCCs that are 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 9275, LIC9276 and LIC999 to the Department on 8/4/2023. On 11/15/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW).
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC CLINICS NESBITT EARLY HEAD START
FACILITY NUMBER: 198017598
VISIT DATE: 09/19/2023
NARRATIVE
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The SWRCB report indicated the facility was inspected and samples were collected on 10/22/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

• Drinking Fountain (C) (19 UG/L) – LPA observed drinking fountain was removed - picture was taken.
Ms. Cashell stated that the facility has not been using the water fountain and was removed after the lead testing. It was located in the adult area and was never been used by the program and there's no plan of replacing it. Facility is using bottled water and never used tap water.
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
A notice of site visit was also provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
A deficiency was cited per Title 22 of CA Code of Regulations. See LIC809D.
Exit interview conducted. Report and Appeal Rights were reviewed with facility representative.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/19/2023 03:55 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: PACIFIC CLINICS NESBITT EARLY HEAD START
FACILITY NUMBER: 198017598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers. (b) Testing results with fractional readings of parts per billion (ppb) 0.5 ppb or greater shall be rounded before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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LPA observed that the drinking water was removed. According to Ms. Cashell, it will not be replaced.
Deficiency was cleared during this visit.
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This requirement is not me at evidenced by the drinking fountain (C) being tested with an Action Level Exceedance (ALE) of 19 UG/L. This poses a potential health and safety risk to children in care.
Per Director, they will make an appointment for the Water Sampling test and submit proof or results if available by Plan Of Correction due date.

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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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