<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017907
Report Date: 03/12/2024
Date Signed: 03/12/2024 02:59:38 PM


Document Has Been Signed on 03/12/2024 02:59 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:INFANT CENTER OF LA VERNE UNITED METHODIST CHURCHFACILITY NUMBER:
198017907
ADMINISTRATOR:NIEVES, VALERIEFACILITY TYPE:
830
ADDRESS:3205 D STREETTELEPHONE:
(909) 596-5369
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:12CENSUS: 9DATE:
03/12/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Co-Director Andria LaBuguenTIME COMPLETED:
03:15 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 03/12/2024, at 12:45 PM, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with facility director Andria LaBuguen, during the visit. Facility is located on United Methodist Church. Facility has a dual license, preschool and infant. Present in the facility are 9 preschool children and 2 teachers/staff. Facility was within ratio & capacity. A Covid risk assessment was conducted.

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 03/12/24.

On 09/13/2023, 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 06/24/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

D – Teacher sink in Room 1 (12.000 UG/L) – Director stated they use Ready Refresh filtered water service for drinking water. LPA observed that the faucet was out of reach of children and during visit Director ensured inaccessibility by placing "out of order/do not use" sign on and around the faucet and securing a plastic bag around the faucet. Director stated that they have a board meeting and will speak to the board to arrange replacement of faucet/pipes. Per Director, facility has a plumber that can help identify and replace outlet. After replacement, director will schedule retesting of outlet and confirm appointment date with LPA via email.

Page 1 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: INFANT CENTER OF LA VERNE UNITED METHODIST CHURCH
FACILITY NUMBER: 198017907
VISIT DATE: 03/12/2024
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
Per Director, water sampler instructed her to include all sinks on the sketch and every sink was tested. Per Director, the outlet was already replaced and retested. Second results were loaded to the water board and were lower but still an exceedance. Sample site ‘D’ is located in preschool classroom 1 operating under preschool license 191504209. Per Director, she informed water sampler that they have 2 different license and he stated that he was going to put everything under 1 license198017907.

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 facility representative, Co- Director Andria LaBuguen Contreras. Appeal rights were provided to facility today.

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

Page 2 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/12/2024 02:59 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: INFANT CENTER OF LA VERNE UNITED METHODIST CHURCH
FACILITY NUMBER: 198017907

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
101700.3(b)(1)

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 met as evidenced by:
1
2
3
4
5
6
7
Per director, board will get plumber to replace fixture and schedule retesting of sample site D in Room 1. Director will confirm with LPA after replacement has been completed and restesting has been scheduled via email before 05/31/24.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the directive above, as one outlet (faucet located in room 1 of preschool) out of four outlets tested with an Action Level Exceedance (ALE). This poses an immediate 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3