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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191225998
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:35:25 AM

Document Has Been Signed on 10/17/2022 10:35 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GLENDALE C. C. CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191225998
ADMINISTRATOR:JEANETTE TASHIROFACILITY TYPE:
850
ADDRESS:1500 N. VERDUGO ROADTELEPHONE:
(818) 549-9442
CITY:GLENDALESTATE: CAZIP CODE:
91208
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 14DATE:
10/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Jeanette Tashiro, DirectorTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 10/17/2022. A COVID 19 risk assessment was conducted prior to entering the facility. LPA arrived at the facility at 8:40 AM and met with Jeanette Tashiro, director who provided a tour of the facility. During this inspection Clifford Gimbert, Assistant Project Manager stop by in the facility to provide a copy of facility sketch with sample sites. There were 14 children and 4 staff present during the inspection.

The purpose of today's inspection is to go over the water lead test results received on 09/12/2022. Results indicate that C, E, G, and J water sources had action level exceedance of lead. The water fountains (sample site J) located at children outdoor playarea. One water fountain located between rooms CDC 115 and CDC 117 and one fountain located between rooms CDC 112 and CDC 114. Both water fountains had a lead result of 7.800. The sink (sample site C) faucet in kitchen which has pull down faucet had a lead result of 31.00. The sink area (sample site E) located at work room CDC 119 the faucet had a lead result of 6.600. The water fountains (sample site G) located at outdoor covered playarea in art area had a lead result of 19.00. LPA observed that faucets in work room CDC 119 and kitchen are not accessible to children in care. The water fountains located in the outdoor playarea (Sample sites: G and J) have been covered with plastic cover to be inaccessible to the children. Per director, she will ask the plumber to disconnect all four water sites that had ALE. LPA spoke with the director, Jeanette Tashiro who stated that preschoolers are provided breakfast, lunch, and a PM snack. Meals and snacks are brought in by Pacific Clinic Head Start catering service. Children use their water bottles for drinking and per director, they refill children water bottles by water dispenser that is located in the kitchen area. LPA observed a water dispenser and extra water containers in the kitchen. LPA took pictures of the water faucets and water fountains during the inspection. A deficiency was cited to ensure that the water faucets noted will not be used as a drinking source or food preparation source for the children.

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.
Exit interview conducted and report was reviewed with director, Jeanette Tashiro at 10:45 AM. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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Document Has Been Signed on 10/17/2022 10:35 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/17/2022 at 08:48 AM
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: GLENDALE C. C. CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191225998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2022
Section Cited
CCR
101700.3(b)(1)-(b)

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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.
This requirement was not met as evidence by record review.
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Per director, they do not use facility faucets or water fountains for children. Meals and snacks are brought in by Pacific Clinic Head Start catering service.
Per director, the faucets in kitchen (C) and Work room (E) has been replaced.
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 Lead test results showed that four water sources (C, E, G, J) had an action level exceedance. LPA observed water fountains (G and J) to be made inaccessible via a plastic cover and per director they are not using water faucet (C and E). This poses a potential health, safety and personal right to children in care.
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and a retesting will be completed by plan of correction due date. The facility will provide a written statement on their plan to continue to ensure that the water sources will not be used as a drinking or food preparation source by the POC date of 11/17/2022.

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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 Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2022


LIC809 (FAS) - (06/04)
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