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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019169
Report Date: 01/12/2023
Date Signed: 01/12/2023 12:48:20 PM


Document Has Been Signed on 01/12/2023 12:48 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:BAXTER MONTESSORI SCHOOLFACILITY NUMBER:
198019169
ADMINISTRATOR:LI ZHOUFACILITY TYPE:
850
ADDRESS:2101 ECHO PARK AVE.TELEPHONE:
(310) 663-6053
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:60CENSUS: 28DATE:
01/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Li Zhou, DirectorTIME COMPLETED:
01:15 PM
NARRATIVE
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On 01/12/2023, at 11:30 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with Director, Li Zhou who guided LPA on a tour of the facility. LPA observed 28 children in care with 4 staff members. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility. During the inspection, LPA observed uncleared adult, Latasha Gutierrez, providing care and supervision. Per director and Latasha, Latasha has been at the facility only today. LPA asked uncleared adult to leave the facility and cannot return to provide care and supervision until fingerprints have been cleared and she has been associated to the facility.

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 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 01/12/2023.

On 10/10/2022, 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 09/22/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BAXTER MONTESSORI SCHOOL
FACILITY NUMBER: 198019169
VISIT DATE: 01/12/2023
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A – Drinking Fountain (6.9 UG/L) – Not in use

Director stated that the drinking fountain located outside of the front building has not been in use since 2019. Per director the children, only use the drinking fountain from the classroom upstairs or bring their water from home. The food preparation faucets did not have lead exeedance levels. Facility has put an "out of order/do not use" sign on and around the drinking fountain and made it further inaccessible by attaching and secured a plastic bag around the outlet. Director completed a Declaration stating that the drinking fountain with lead exceedance will not be used.

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

In regard to the lead exeedance, the facility is not being cited as none of the faucets with lead exeedance are being used for consumption or food preparation.

The facility is being cited a Type A deficiency for an uncleared adult under Title 22 Regulation, 101216(i)(1).

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview conducted and a copy of this report was provided to, Director, Li Zhou along with Notice of Site Visit and Appeal Rights. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/12/2023 12:48 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: BAXTER MONTESSORI SCHOOL
FACILITY NUMBER: 198019169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2023
Section Cited

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Personnel Requirements: Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: Obtain a California clearance or a criminal record exemption as required by law or Department regulations...
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Uncleared adult Latasha Gutierrez left the facility and director stated the facility will not be using Latasha as an aide anymore.
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This requirement was not met as evidence by: Based on observation, Latasha Gutierrez was providing care and supervision to child without a criminal background clearance. This poses an immediate health and safety 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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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