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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017751
Report Date: 12/07/2023
Date Signed: 12/07/2023 10:11:16 AM


Document Has Been Signed on 12/07/2023 10:11 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:HSA PASITOS HEAD START LEGEND PRE SCHOOLFACILITY NUMBER:
198017751
ADMINISTRATOR:RICO-NUNEZ, LETICIAFACILITY TYPE:
850
ADDRESS:10125 CALIFORNIA AVENUETELEPHONE:
(323) 249-0511
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:30CENSUS: 13DATE:
12/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Alicia NunezTIME COMPLETED:
10:40 AM
NARRATIVE
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On 12/07/2023, about 9:00AM, Licensing Program Analyst (LPA) T. Tran conducted an unannounced case management Lead inspection at HSA Pasitos Head Start Legend preschool. Upon arrival, LPA met with Site Supervisor, Alicia Nunez, and we toured the facility. LPA observed proper care and supervision.

The purpose of today's inspection was to go over the water lead test results received on 07/07/23. Results show that two water sources had action level exceedance of lead. The sinks located in classroom B had a lead result of 8.11. Per facility representative, classroom B is currently unused due to low enrollment. LPA observed that both sinks were covered with bags and tape to make them inaccessible to children. When that classroom is reopened, facility will install a portable sink for children to wash their hands. A deficiency was cited to ensure that the sinks 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.

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

Exit interview conducted and report was reviewed with the facility representatives, Alicia Nunez.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023
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 12/07/2023 10:11 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: HSA PASITOS HEAD START LEGEND PRE SCHOOL
FACILITY NUMBER: 198017751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/07/2023
Section Cited
CCR
101700.3(b)(1)–(b)

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Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by record review. Lead test results showed that two water sources in classroom B had an action level exceedance.
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On 07/07/23, facility had provided a written statement on their plan to continue to ensure that the water sources will not be used as a drinking or food preparation source. Photo images of sinks in classroom B was covered by black bags with tape labeled as out of order, do not use.
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LPA observed the sinks to be made inaccessible with plastic bags and tape. This is a potential risk to the health and safety of the children in care.
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Classroom B is currently unused due to low enrollement. Facility will install portable sink when the class is reopened.
POC was cleared during today's visit.

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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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2