191204862-9-13-2023-33-CC-TRAO-CVMN24-20230913100408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191204862
Report Date: 09/13/2023
Date Signed: 09/13/2023 10:04:13 AM

Document Has Been Signed on 09/13/2023 10:04 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HARRIET TUBMAN PRESCHOOL		FACILITY NUMBER:	191204862
ADMINISTRATOR:	JOHNSON, WILLIE MAE		FACILITY TYPE:	850
ADDRESS:	36WEST MONTANA STREET		TELEPHONE:	(626) 794-5620
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY: 9	TOTAL ENROLLED CHILDREN: 9	CENSUS: 1	DATE:	09/13/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Willie Mae Johnson, Licensee/Director		TIME COMPLETED:	10:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/13/2023, at 9:02 AM, Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Case Management inspection to verify that lead testing was completed in accordance to Written Directives outlined in PIN 21-21.1-CCP. A COVID 19 risk assessment was conducted prior to entering the facility. LPA met with Licensee/Director Willie Mae Johnson and stated the purpose of the visit. There was one child and one staff present at the time of visit. Facility was within ratio and capacity. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Licensee clarified that lead testing was not completed since she never used any water outlets for food preparation and drinking. LPA reviewed the Preschool Handbook and it indicated that parents are responsible for providing lunch and drinks. According to Ms. Johnson, a pre-packaged food is available for morning and

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HARRIET TUBMAN PRESCHOOL	FACILITY NUMBER: 191204862
	VISIT DATE: 09/13/2023

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afternoon snacks. She uses bottled water and a water dispenser which is not attached to any of the water outlets. During this visit, Ms. Johnson has provided a written Declaration (LIC855) that no water outlets are being used for drinking nor for food preparation. Ms. Johnson understood that if the center decides to use an outlet for drinking or food preparation in the future, center must first test for lead following the most current written directives prior to initial use.

No deficiency was cited during this inspection.

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

Exit interview conducted and report was reviewed with Licensee/Director Willie Mae Johnson.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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