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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670563
Report Date: 07/19/2023
Date Signed: 07/19/2023 09:53:10 AM

Document Has Been Signed on 07/19/2023 09:53 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LBUSD-CENTRAL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670563
ADMINISTRATOR:AMY PAYNEFACILITY TYPE:
850
ADDRESS:1133 RHEATELEPHONE:
(562) 591-7717
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 88TOTAL ENROLLED CHILDREN: 13CENSUS: 9DATE:
07/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Amy Payne, Coordinating TeacherTIME COMPLETED:
10:30 AM
NARRATIVE
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On 07/19/2023 at 9:40 AM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management Inspection and met with Coordinating Teacher, Amy Payne. LPA disclosed the purpose of the inspection and was granted entry into the facility by Coordinating Teacher.

There were nine children and five staff present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that all the classroom drinking fountains, totaling six water sources, have action level exceedance (ALE) of lead: RM-301 drinking fountain results 5.64 and 19.2, RM-302 drinking fountain results 6.0 and 21.0, RM-305 drinking fountains result of 9.63 and 19.9.

At 9:45 AM. LPA observed and took pictures of the water sources with ALE. Water sources were observed to be inaccessible to children covered completely with black plastic and with a sign indicating water sources to not be in service. Per Facility Representatives, children have been provided disposable water bottles. LPA observed water bottles being used and brought out as children were transitioning for outdoor play. Per Coordinating Teacher, parents were notified via letters sent out and LPA was provided notification letter at time of inspection. Per Program Administrator and 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 Coordinating Teacher, Amy Payne.
Report Ends - Page 1 of 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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Document Has Been Signed on 07/19/2023 09:53 AM - It Cannot Be Edited


Created By: Katrina Chicote On 07/19/2023 at 09:44 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LBUSD-CENTRAL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191670563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2023
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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LPA observed all water sources to be made inaccessible to children with black plastic wrapped completely around it and signs posted indicating water sources are not in use. LPA observed disposable water bottles available for drinking water at time of inspection. Clearing deficiency on site.
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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 six 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 Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


LIC809 (FAS) - (06/04)
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