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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201896
Report Date: 05/07/2024
Date Signed: 05/07/2024 02:51:15 PM

Document Has Been Signed on 05/07/2024 02:51 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LA CRESCENTA PRESBYTERIAN CHURCH CTR. FOR CHILDREFACILITY NUMBER:
191201896
ADMINISTRATOR/
DIRECTOR:		CHAMBERS, PATRICIAFACILITY TYPE:
850
ADDRESS:2902 MONTROSE AVETELEPHONE:
(818) 249-8124
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: DATE:
05/07/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Patricia Chambers TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. Upon arrival LPA met with Facility Representative Patricia Chambers , who guided LPA on a tour of the facility. There were 41 children present during the time of the inspection.

Census was taken. LPA observed 41 children with 7 staff members playing outdoors .

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 prior to the inspection.

On 08/05/2022 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 06/23/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

-C which is located in the Cafeteria .

- D which is located in the classroom 101.

- J which is located in the hallway .

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LA CRESCENTA PRESBYTERIAN CHURCH CTR. FOR CHILDRE
FACILITY NUMBER: 191201896
VISIT DATE: 05/07/2024
NARRATIVE
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Director states that classroom 101 not in use and Faucet J was removed permanently. Faucet C is not used by the children and will be either fixed or removed .

During the visit LPA observed Faucet J permanently removed , Faucet C and D covered with the plastic bags and tapped.(Pictures Taken ).Per Facility representative faucets either will be fixed or removed .

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

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Notice of Site Visit was provided and must remain post for 30 consecutive days. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

An exit interview conducted with Facility Representative Patricia Chambers and a copy of this report was provided.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2024 02:51 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 05/07/2024 at 02:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LA CRESCENTA PRESBYTERIAN CHURCH CTR. FOR CHILDRE
FACILITY NUMBER: 191201896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2024
Section Cited
CCR
101700.3(b)(1)

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Testing results with fractional ppb readings of 5.5 ppb or greater shall be rounded up to the nearest whole number...(1) A result with values of 5.5 or greater shall be deemed and Action Level Exceedance
This requirement was not met as evidence by:
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Per Facility Representative facility will come in agreement with the church and either remove the facet or replaced it and redo testing .
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Facility had a lead exeedance reported to the Department . Facility had a 3 faucets with the lead exceedance .
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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:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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