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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191599868
Report Date: 03/15/2024
Date Signed: 03/15/2024 11:27:29 AM

Document Has Been Signed on 03/15/2024 11:27 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:HARRISON/CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191599868
ADMINISTRATOR:KYM ALLENFACILITY TYPE:
850
ADDRESS:425 EAST HARRISONTELEPHONE:
(909) 397-4622
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 19DATE:
03/15/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Kristina Sagehorn-Early childhood special education teacherTIME COMPLETED:
12:00 PM
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On 03/15/2024, at 09:40 AM, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with Early Childhood special education teacher, Kristina Sagehorn during the visit. Facility is located at Harrison elementary school. Visitors must check in/sign in at the front office, then entrance will be permitted at the right far end side gate. Facility operates out of three classrooms. Rm 30 and 31 service preschool age from 3-5. Rm 32 servicing toddlers ages 2-3, in pull ups and potty training. All classrooms share a single playground with staggered play times. Present in the facility are 4 toddlers and 15 preschool age children and 6 teachers and staff. Facility was within ratio & capacity. A Covid risk assessment was conducted.

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 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 on 03/07/24 via email:

On 12/30/2022, 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 12/10/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

See LIC809C for continuation…
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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: HARRISON/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191599868
VISIT DATE: 03/15/2024
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 B – Right water fountain outside of Rm 31 (8.500 UG/L) – Teacher stated the children do not use that water fountain. Water fountain being used is fountain near playground outside of Rm 32 classroom. LPA observed that the water fountain area is currently being used as a storage for unused sandbox, painting easel, metal storage rack and a water table. During visit, teacher ensured inaccessibility by placing "out of order/do not use" sign on and around the fountain and securing a plastic bag around the spigot. Photo was captured. Facilities licensing planner was contacted and stated they will remove the spigot and place a cap making water source inaccessible and will send proof to LPA S Li by 3/29/24 via email.

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.

Exit interview conducted and report was reviewed with the facility representative, Kristina Sagehorn. Appeal rights were provided to facility today.

A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/15/2024 11:27 AM - It Cannot Be Edited


Created By: Stephanie Li On 03/15/2024 at 11:05 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: HARRISON/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191599868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1) California Lead Action Level at...Centers. (b) Testing results with...0.5 ppb or greater...(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:
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Facilities licensing planner will remove water founatin spigot and cap off the source of water and send photo proof to LPA via email by 3/29/24.
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Based on record review, the licensee did not comply with the directive above, as one outlet (right water fountain located outside along room 31) out of fifteen outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to children in care.
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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:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024


LIC809 (FAS) - (06/04)
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