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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870758
Report Date: 12/02/2022
Date Signed: 12/02/2022 12:31:32 PM

Document Has Been Signed on 12/02/2022 12:31 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ONE HUNDRED SECOND STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870758
ADMINISTRATOR:VENUS STOVALLFACILITY TYPE:
850
ADDRESS:1925 EAST 102ND STREETTELEPHONE:
(323) 569-8159
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 37DATE:
12/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Venus Stovall, PrincipalTIME COMPLETED:
12:40 PM
NARRATIVE
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On December 2, 2022, at 11:35 a.m., Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection and met with Principal Venus Stovall. LPA disclosed the purpose of the inspection and was granted entry into the facility by Principal..

There were 37 children and 14 staff present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that two water sources have action level exceedance (ALE) of lead. The drinking fountain located outside of Room#1 and the drinking fountain outside Room#2 had a lead exceedance of 5.9 and 5.1.

At 11:45 a.m. LPA observed and tested the water sources with ALE. Water sources were operable. LPA received email from Los Angeles Unified School District (LAUSD) lead exceedance team prior to today's inspection with notification of completed corrections. Filters and tubing were added to both affected water sources. Principal provided LPA with retest results showing levels of 2.1 and under 1 for identified sources. LPA observed both initial and retest lead results posted outside the main office where they can be seen by parents. A deficiency was cited to ensure that the water faucets with the exceedance will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

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

Exit interview was conducted and Plans of Correction was reviewed and developed with Principal. A copy of this report and appeal rights were discussed and left with Principal, Venus Stovall, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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 12/02/2022 12:31 PM - It Cannot Be Edited


Created By: Denise Gibbs On 12/02/2022 at 12:04 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: ONE HUNDRED SECOND STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
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 shall be rounded up to the nearest whole number, 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 was not met as evidence by:
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Water sources identified with ALE were corrected prior to inspection. LPA observed new faucets and filters added to water sources. LPA received confirmation email that Tubing and filters have been replaced along with completed, LIC 9276 Follow-Up checklist for Water Sampling During a Corrective Plan. Principal provided retest
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Based on record review the licensee did not ensure water sources at facility meet lead requirements. Lead test results showed that two water sources have an action level exceedance.
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results showing water source levels are down to 2.1 and under 1.

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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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2022


LIC809 (FAS) - (06/04)
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