<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870897
Report Date: 06/27/2024
Date Signed: 06/27/2024 04:02:43 PM

Document Has Been Signed on 06/27/2024 04:02 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:USC HEAD STARTFACILITY NUMBER:
191870897
ADMINISTRATOR/
DIRECTOR:		JOANNA WILLIAMSFACILITY TYPE:
850
ADDRESS:741 WEST 27TH STREETTELEPHONE:
(213) 743-2466
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 119TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/27/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Patty VenegasTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/27/2024, about 2:45PM, Licensing Program Analysts (LPAs) T. Tran and A. Carter conducted an unannounced case management inspection at USC Head Start. Upon arrival, LPAs met with site supervisor, Patty Venegas and we toured the facility. Per site supervisor, no children at the center due to summer break.

The purpose of today's inspection was to go over the water lead test results received on 6/03/24. Results show that two water sources had action level exceedance of lead, located in the kitchen area with the lead result of 13 ppb. LPA observed that both sinks were covered with trash bags and tape pending for the faucets to be replaced and retested mid July. Facility will update LPA with the new result. A deficiency was cited to ensure that the water faucets noted would not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were observed by the LPAs 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 conducted and report was reviewed with the facility representative, Patty Venegas.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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 Has Been Signed on 06/27/2024 04:02 PM - It Cannot Be Edited


Created By: Tiffanie Tran On 06/27/2024 at 03:08 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: USC HEAD START
FACILITY NUMBER: 191870897

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
HSC
101700.3(b)(1)–(b)

1
2
3
4
5
6
7
 Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that two water sources had an action level exceedance.
1
2
3
4
5
6
7
Per facility representative, both fixtures with lead exceedance were covered with trash bags pending for the faucet to be replace and retest was scheduled for mid July. Facility will update RO with the resting result upon completion.
8
9
10
11
12
13
14
LPA observed the sinks located in the kitchen area to be made inaccessible with plastic bags and tape pending for the faucets to be replaced and rested. This is a potential risk to the health and safety of the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2