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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605034
Report Date: 07/13/2023
Date Signed: 08/08/2023 02:31:08 PM


Document Has Been Signed on 08/08/2023 02:31 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/07/2023 02:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

NARRATIVE
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On 08/08/2023 at 2:00 PM, Licensing Program Analysts (LPAs) Katrina Chicote and Raul Navarro conducted an Unannounced Case Management Inspection and met with Program Coordinator, Cristabel Rodriguez, and Tiffany Sanchez, Coordinating Teacher. LPAs disclosed the purpose of the inspection and was granted entry into the facility and was provided tour. Facility is made up of two rooms RM B-1 and RM B-2 located on Lincoln Elementary School campus. There were no children observed at facility, per Program Coordinator facility is currently not operating through the Summer.

The purpose of today's inspection was to discuss the water lead test results. Results show that all the classroom drinking fountains, totaling two water sources, have action level exceedance (ALE) of lead: RM B-1 drinking fountain (labeled H) results 7.48 ppb and RM B-2 drinking fountain (labeled F) results 48.5 ppb.

At 2:09 PM, LPAs observed and took pictures of the water sources with ALE. LPAs tested water sources and observed to be operable at time of inspection. Per Program Coordinator, water sources have already been remediated and another test will be conducted on Friday, 08/11/2023. Per Facility Representatives, program currently not operating for the Summer but children will be provided disposable water bottles for water source once program begins operating on 08/30/2023. Per Coordinating Teacher, all meals are delivered by LBUSD Nutrition Services and no meals are prepared on site.

A deficiency was cited to ensure that the water sources with the exceedances will not be used as a drinking source or food preparation source for the children.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representatives.
Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
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 2


Document is an Amendment of Original Document on 08/07/2023 02:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: LBUSD-LINCOLN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191605034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb 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... Action Level Exceedance. This requirement was not met as evidence by:
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FR states she will provide test results for water once received and facility is currently not operating. FR states children will be provided water bottles. POC due on POC date.
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Based on record review the Licensee did not ensure water sources at facility to meet lead requirements. Lead test results showed that two water sources have an action level exceedance. This poses a potential health, safety, and personal rights 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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2