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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593623
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:54:47 PM

Document Has Been Signed on 02/01/2023 03:54 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MAXSON HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191593623
ADMINISTRATOR:ALMA GONZALESFACILITY TYPE:
850
ADDRESS:12380 FELIPETELEPHONE:
(626) 652-4250
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 75TOTAL ENROLLED CHILDREN: 80CENSUS: 35DATE:
02/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Smarah Baker, Program Facilitator TIME COMPLETED:
04:15 PM
NARRATIVE
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On 02/01/2023, at 2:15 PM, Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with program facilitator, Samarah Baker, during the beginning of the visit, Program Facilitator Claudia Casillas took over the inspection. Also present in the facility were 35 day care children and 8 teachers/staff. Facility was within ratio & capacity. A COVID 19 risk assessment was conducted prior to entering the facility.

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 program facilitator 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 LIC 9275 to LPA on 11/9/2022. On 12/21/2022, 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 10/05/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:
• A – Sink Faucet Fixture E In Room K2 (6.0 UG/L) – Faucet was replaced and re-tested passing the test. Pictures were taken
• A – Sink Faucet Fixture F In Room K2 (9.0 UG/L) – Faucet was replaced and re-tested passing the test. Pictures were taken ------------------------ pg. 1 of 2 ---------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAXSON HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 191593623
VISIT DATE: 02/01/2023
NARRATIVE
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• A – Water Fountain Fixture D located on playground (16.0 UG/L) – Fountain was removed- a new water filtration system will be installed on 2/2/2023 and re-tested on 3/9/2023. Pictures were taken.

Program facilitator stated that the facility has not been using these faucets or water fountain since the beginning of the pandemic. Children carry their own water bottles and or they have water jugs and disposable cups available for the children. The use of the faucets and fountain has been and was terminated when the facility was informed by the analyst that it was exceeding acceptable levels. The faucet’s in the classroom have been replaced and re-tested passing the water test. The water fountain outside has been removed tape is covering the water line.

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

See LIC809D for Type B deficiency cited in accordance with California Code od Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.


A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

A notice of site visit was also 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 the facility representative, Claudia Casillas.

------------------------------------------------pg 2 of 2 --------------------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/01/2023 03:54 PM - It Cannot Be Edited


Created By: Roxana Lopez On 02/01/2023 at 03:03 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: MAXSON HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 191593623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/08/2023
Section Cited
CCR
101700.3(b)(1)

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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 me at evidenced by
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Per program facilitator the faucets and fountain found to be in lead exceedance in room K2 and the playground have not been used since the beginning of the pandemic. Faucets and foutain were removed. The faucets in the classroom has been replaced and re-tested passing the water test.
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Based on record review, the licensee did not comply with the directive above, as three outlets tested with an Action Level Exceedance (ALE). This poses a potential health and safety risk to children in care.
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The water fountain was removed the water line was taped. Water system will be replaced on 2/2/2023 and will be re-tested on 3/9/2023. Per program facilitator they will submit picture once water fountain has been replaced and submit new results once tested.

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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
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