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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671133
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:49:36 PM

Document Has Been Signed on 08/02/2023 03:49 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LBUSD-TWAIN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191671133
ADMINISTRATOR:KELLIE HAUSERFACILITY TYPE:
850
ADDRESS:4666 SUNFIELD AVE.TELEPHONE:
(562) 425-2735
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 64TOTAL ENROLLED CHILDREN: 22CENSUS: 18DATE:
08/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kellie Hauser, Coordinating Teacher TIME COMPLETED:
04:00 PM
NARRATIVE
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On 08/02/2023, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management Inspection and met with Kellie Hauser, Coordinating Teacher. LPA disclosed the purpose of the inspection and was granted entry into the facility and was provided guided tour. Facility is made up of two classrooms: Rooms 401 and 402. Census was taken. LPA observed 18 children with three staff during inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that the classroom faucet in in Room 401 to have action level exceedance (ALE) of lead with results of 6.03 ppb. Per Coordinating Teacher, water source is not used for drinking water or food preparation but all water sources were tested by LBUSD.

LPA observed and took pictures of the water source with ALE. LPA tested faucet which was observed to be inoperable at time of inspection. Per Coordinating Teacher, children bring their own personal water bottles and are also provided small disposable water bottles for refills or if children forget water bottles. LPA was provided letter distributed to parents by Program Coordinator via email. Per Coordinating Teacher, no meals are prepared on site and all meals are delivered by LBUSD Central Kitchen.

A deficiency was cited to ensure that the water sources with the exceedance 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 Facility Representative, Kellie Hauser

Report Ends - Page 1 of 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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 08/02/2023 03:49 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/02/2023 at 01:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LBUSD-TWAIN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191671133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
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 faucet with ALE to be turned off at time of inspection. Per FR, water source is not used for drinking or food prep. LPA observed water bottles available for children for drinking water. Clearing deficiency on site.
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Based on record review the Licensee did not ensure water source at facility to meet lead requirements. Lead test results showed that one water source has 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: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
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