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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020088
Report Date: 08/02/2023
Date Signed: 08/02/2023 12:05:45 PM


Document Has Been Signed on 08/02/2023 12:05 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:JORDAN PLUS HEAD STARTFACILITY NUMBER:
198020088
ADMINISTRATOR:CARRIE J. BROWN & SHELLI SFACILITY TYPE:
850
ADDRESS:171 W. BORT STTELEPHONE:
(562) 422-1281
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:45CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Faclity RepresentativesTIME COMPLETED:
12:35 PM
NARRATIVE
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On 08/02/2023 at 11:40 AM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management Inspection and met with Keokuk Legarde (ELCM), Maria Harris (Program Administrator), and Vicente Alvarez (ELCM). LPA disclosed the purpose of the inspection and was granted entry into the facility and was provided guided tour. Facility is made up of two classrooms RM-1 Preschool and RM-2 Early Head Start which is located on Jordan Plus High School campus.

There were no children but four staff present during the inspection. LPA did not observe any children in any classroom during inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that the classroom drinking fountain in RM-2 labeled F has action level exceedance (ALE) of lead with results of 8.0 ppb.

At 11:47 AM, LPA observed and took pictures of the water source with ALE. LPA observed drinking fountain in RM-2 to be inaccessible to children completely covered with plastic. LPA observed water jugs with paper cups available for children drinking water in classroom. Per ELCM, parents will be notified pending a letter distributed by LBUSD. Per ELCM, no meals are prepared on site and all meals are delivered by Head Start Kitchen.

A deficiency was cited to ensure that the water sources with the exceedances will not be used as a drinking source or food preparation source for the children.

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

Exit interview was conducted and report was reviewed with Facility Representatives.

Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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 08/02/2023 12:05 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: JORDAN PLUS HEAD START
FACILITY NUMBER: 198020088

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb 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... Action Level Exceedance. This requirement was not met as evidence by:
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LPA observed water sourcs to be made inaccessible to children at time of inspection and LPA observed water jugs available for drinking water. Clearing deficiency on site.
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Based on record review the Licensee did not ensure water sources at facility to meet lead requirements. Lead test results showed that one water source has an action level exceedance. This poses a potential health, safety, and personal rights 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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2