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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019539
Report Date: 01/30/2023
Date Signed: 01/31/2023 11:20:27 AM


Document Has Been Signed on 01/31/2023 11:20 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:OLIVE TREE LEARNING ACADEMYFACILITY NUMBER:
198019539
ADMINISTRATOR:JUNG A KIMFACILITY TYPE:
850
ADDRESS:1318 S. BERENDO ST.TELEPHONE:
(213) 378-0512
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:56CENSUS: 28DATE:
01/30/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jung Kim TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Director Jung Kim

During the inspection 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

Facility provided a copy of the facility sketch, LIC 9276, and LIC 9275 to LPA Lee during the inspection.

On 09/08/2022, 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 08/20/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:
  • A sink faucet located in the kitchen of the main building for preschool license (14.0 UG/L) – This sink was not used since the results of the initial test. Sink was replaced by facility and retested on 12/10/22. Results dated 12/14/22 show that the ppb is no longer over 5.5 UG/L. New level observed in the results was 2.2 UG/L per documents provided during the inspection.

LPA Lee observed the sink that was replaced in the kitchen. Even before the sink was replaced, the facility did not use the sink for any type of food preparation or consumption. LPA Lee observed another sink faucet located right next to the sink that was tested to exceed the lead levels.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
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: OLIVE TREE LEARNING ACADEMY
FACILITY NUMBER: 198019539
VISIT DATE: 01/30/2023
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Since the facility has another sink in the kitchen that was always available to use and passed the initial test on 09/08/22 LPA did not cite the facility during todays inspection.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Jung Kim. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023
LIC809 (FAS) - (06/04)
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