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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020493
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:20:00 PM


Document Has Been Signed on 02/23/2024 03:20 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTONFACILITY NUMBER:
198020493
ADMINISTRATOR:JENNY LEFACILITY TYPE:
850
ADDRESS:500 E. 10TH STTELEPHONE:
(626) 815-4727
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:29CENSUS: 0DATE:
02/23/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Prinicipal Donna MartynTIME COMPLETED:
03:40 PM
NARRATIVE
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On 02/23/2024, at 12:30PM, Licensing Program Analyst (LPAs)Mary Silva and Saul Valenzuela conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA(s) met with principal Dr. Donna Martyn and Juan Ruelas Intervention Success Coach, whom reason for visit was explained. LPA(s) were taken on a tour of facility. No children or staff were present during the inspection. There are 25 children currently enrolled. This is a preschool program with one session from 8:00am-11:00am.

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 Licensing staff on 01/28/24.
On 11/01/2023, 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 10/25/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead
exceedance levels were as follows:
A – Sink/Drinking Faucet in Room 20 (27.400 UG/L) – Faucet currently not in use
A30 – Sink/Drinking Faucet in Room 20 (31.600 UG/L) – Faucet currently not in use
B – Sink Faucet in Room 20 (28.500 UG/L) – Faucet currently not in use

Principal stated that the facility was using faucet next to the bathrooms labeled A and A30 for hand washing and drinking. The water outlet labeled B located in the north end of classroom (teacher work room) are not being used for drinking. The teacher work room is used to prepare art and craft activities. Children do not have access to the teacher’s work room.
When the facility was informed it was exceeding acceptable levels of lead the facility covered water outlets with plastic bags
making it inaccessible to children and staff. Facility provides water bottles for drinking and are utilizing the restroom across the quad for hand washing.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mary SilvaTELEPHONE: (323) 558-2711
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON
FACILITY NUMBER: 198020493
VISIT DATE: 02/23/2024
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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

Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D
(deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are
being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall
result in an immediate civil penalty of $100.

An exit interview was conducted, a copy of the report, PIN 21-21-CCP and appeal rights was provided to Principal Dr. Donna Martyn.
________________________________________Page 2_____________________________________
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mary SilvaTELEPHONE: (323) 558-2711
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 02/23/2024 03:20 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON
FACILITY NUMBER: 198020493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2024
Section Cited
CCR
101700.3(b)(1)

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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:
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Facility will remediate outlets and have them retested before use. Prinicpal will continue to provide the status and
updates by POC due date of 03/25/24.
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Based on observation the licensee did not
comply with the directive above, as three out of three outlets tested with an Action Level Exceedance
(ALE). Water outlets labeled A A30(next to the bathroom) and B(Teacher's work room).
This poses a potential Health and
Safety risk to children in care.

Principal stated the outlets found to be in lead exceedance, have been covered with a plastic bag and made inaccessible to children and staff.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mary SilvaTELEPHONE: (323) 558-2711
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3