<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500173
Report Date: 09/22/2023
Date Signed: 09/22/2023 12:33:20 PM

Document Has Been Signed on 09/22/2023 12:33 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:COVINA FIRST BAPTIST PRESCHOOLFACILITY NUMBER:
191500173
ADMINISTRATOR:JENNIFER SMITHFACILITY TYPE:
850
ADDRESS:200 NORTH SECOND AVETELEPHONE:
(626) 332-5875
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 89TOTAL ENROLLED CHILDREN: 22CENSUS: 17DATE:
09/22/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Director Jennifer SmithTIME COMPLETED:
12:45 PM
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 09/22/2023, at 11:30 AM, Licensing Program Analyst (LPA) Mary Silva conducted an unannounced case management lead testing exceedance inspection for an Action Level Exceedance (ALE) detected in two water fixtures in the facility. LPA(s) were greeted by Jennifer Smith, director and was led on a tour of the facility. Also present in the facility were 17 daycare children and 2 teachers/staff. Facility was within ratio & capacity. Analyst 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 Lead Teacher 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,all outlets tested were not properly labeled. In addition, required forms LIC 999, LIC 9276, and LIC 9275 have been submitted to LPA on 09/21/2023. On 05/19/2023, 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 09/14/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

Sample Site A – Room 111 (110.000 UG/L) – Faucet currently not in use.
Sample Site B – Room 109 (120.000 UG/L) – Faucet currently not in use.
Sample Site C – Kitchen Faucet (5.9.000 UG/L) – Faucet currently not in use.
Sample Site D – Room 103 (22.000 UG/L) – Faucet currently not in use.
Sample Site E – Room 101 (35.000 UG/L) – Faucet currently not in use.
Page 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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 3
Document Has Been Signed on 09/22/2023 12:33 PM - It Cannot Be Edited


Created By: Mary Silva On 09/22/2023 at 12:03 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: COVINA FIRST BAPTIST PRESCHOOL
FACILITY NUMBER: 191500173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
Section Cited
CCR
101700.3(b)(1)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
Director stated the outlets labeled A-H found to have lead exceedance of 5.5 and greater will be remediated. Director has covered the all faucets and posted appropriate "closed/do not use" signage immediately. Facility provides water gallons and paper cups in each classroom.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the directive above, as eight outlets out of twelve outlets tested with an Action Level Exceedance (ALE). This poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
Director will continue to provide the status and
updates regarding the remedation of outlets A-H and will re-test outlets prior to use. POC due date is 10/20/23.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Mary Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
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: COVINA FIRST BAPTIST PRESCHOOL
FACILITY NUMBER: 191500173
VISIT DATE: 09/22/2023
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
26
27
28
29
30
31
32
Sample Site F – Room 104 (33.000 UG/L) – Faucet currently not in use.
Sample Site G – Room 110 (13.000 UG/L) – Faucet currently not in use.
Sample Site H – Room 112 (12.000 UG/L) – Faucet currently not in use.

Director stated the facility has not used the faucets in the classrooms A,B,D-H for drinking only used for hand washing. Children bring water bottles and facility provides drinking water in-doors and out-doors. LPA observed water gallons and paper cups in the classrooms. The faucet in the kitchen is used to wash containers. No food is prepared in the kitchen. Facility provides am/pm snacks and children bring lunch from home. The facility has placed an "out of service" signs on faucets A-H, making them inaccessible to children and staff. Director stated, the facility will remediate outlets A-H and retest outlets prior to use.

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.


Exit interview conducted, appeal rights were given and report was reviewed with the director, Jennifer Smith
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3