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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018769
Report Date: 08/01/2023
Date Signed: 08/01/2023 04:29:42 PM


Document Has Been Signed on 08/01/2023 04:29 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PLAZA DE LA RAZA C.D.S.- MAIZELANDFACILITY NUMBER:
198018769
ADMINISTRATOR:CABOT, NORAYMAFACILITY TYPE:
830
ADDRESS:7601 CORD AVE.TELEPHONE:
(562) 205-2789
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:96CENSUS: 33DATE:
08/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Supervisor, Patty Arrua TIME COMPLETED:
04:50 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 8/1/2023, at 3:50 PM, 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 facility supervisor, Patty Arrua, during the visit. There was no children present on this date. 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 12/1/2022.

On 12/12/2022, 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 10/8/2022. Sink Faucets reported with 5.5 ppb or greater lead exceedance levels were as follows:
 BB– Sink Faucet in room # 12 (Head-start) (5.8 UG/L)
 DD– Sink Faucet in FSA office (6.5 UG/L)
 S – Sink Faucet in room # 6 (Head -start) (6.5 UG/L)
----------------------------------------------------------pg. 1 of 2 ---------------------------------------------------------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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: PLAZA DE LA RAZA C.D.S.- MAIZELAND
FACILITY NUMBER: 198018769
VISIT DATE: 08/01/2023
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
Per Supervisor- the faucets mentioned above are all located in the preschool license- LPA took a tour of both preschool and infant license and observed that results were uploaded to the wrong license. LPA asked for an updated facility sketch documenting what faucets belong to this license.

LPA took pictures of faucets in preschool classrooms. Initially, these faucet was tested on 10/8/2022 and did not pass. Faucets have all been replaced and were retested on 3/5/2023- results received on 4/24/2023 showed that these faucets have been cleared and are now in compliance.

See LIC809D for Type B deficiency cited. LPA did clear deficiency on this date and will provide facility representative with a copy of clearance on this date

Appeal rights were provided to facility today. A notice of site visit was also provided and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Supervisor Patty Arrua.

-----------------------------------------------------------pg. 2 of 2 ---------------------------------------------------------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/01/2023 04:29 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: PLAZA DE LA RAZA C.D.S.- MAIZELAND
FACILITY NUMBER: 198018769

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2023
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 me at evidenced by
1
2
3
4
5
6
7
Per Director the 3 faucets have been replaced and retested. The Department reived Passing testing results on 4/24/2023.
8
9
10
11
12
13
14
Based on ispection, the licensee did not comply with the directive above, as that 3 sink faucets BB, DD and S tested with an Action Level Exceedance (ALE) of 5.8, 5.9 and 8.00 ppb. 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 VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3