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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270908
Report Date: 09/16/2022
Date Signed: 09/16/2022 03:06:12 PM


Document Has Been Signed on 09/16/2022 03:06 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:ROSSMOOR CHILDREN'S CENTERFACILITY NUMBER:
304270908
ADMINISTRATOR:ROSEMARIE PRYIA MADAWALAFACILITY TYPE:
850
ADDRESS:4161 GREEN AVENUETELEPHONE:
(562) 431-6553
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:127CENSUS: 41DATE:
09/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Priya Madawala, directorTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dean Valencia conducted an unannounced Case Management Inspection, met with director Priya Madawala to discuss the Lead Sampling testing conducted. A physical plant walk through was conducted and census of staff/children was taken in individual classrooms. During the inspection there were 41 children present and 7 staff. During the inspection, LPA Valencia ensured the Lead Sample Report is posted.

Director stated that they reported two faucets that reported exceedance lead levels. One faucet used by staff, will be replaced and relined, the second which is not used by anyone will be made inaccessible by a cover. The supply line to the first faucet will be replaced as well. Director stated that they will retest the first that registered over 5.5 ppb lead level during the initial test. Once the second lead test is completed a correction and test result will be submitted to LPA.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
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 09/16/2022 03:06 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: ROSSMOOR CHILDREN'S CENTER
FACILITY NUMBER: 304270908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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The above was not met as evidenced by:
The facility registered two seperate faucets in the facility with lead levels exceeding 5.5ppb.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
LIC809 (FAS) - (06/04)
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