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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402063
Report Date: 12/02/2022
Date Signed: 12/02/2022 11:24:44 AM

Document Has Been Signed on 12/02/2022 11:24 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WEIGAND ELEMENTARY SCHOOL ROOM 6FACILITY NUMBER:
197402063
ADMINISTRATOR:TAMARA HONEGANFACILITY TYPE:
850
ADDRESS:10401 WEIGAND AVENUETELEPHONE:
(323) 567-9606
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
12/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Tamara Honegan, PrincipalTIME COMPLETED:
11:30 AM
NARRATIVE
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On December 2, 2022, at 9:40 a.m., Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection and met with Principal Tamara Honegan. LPA disclosed the purpose of the inspection and was granted entry into the facility by Principal..

There were 15 children and three 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 inside the classroom and the drinking fountain in the outdoor play area had a lead exceedance of 216.97 and 18.82.

At 10:00 a.m. LPA observed and took pictures of the water sources with ALE. Water sources were observed to be inaccessible to children. LPA observed that water is turned off. Per staff, water is made readily available to children via water bottles provided at the facility. LPA observed cases of water bottles. LPA observed posted lead results in the classroom, accessible to parents if needed. LAUSD Lead exceedance team has begun to correct the ALE by shutting off the water and is in the process of installing filters to the affected water sources. LAUSD facility maintenance has not given a date to begin work. 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.

Per Principal, all meals are prepackaged and delivered daily by Los Angeles Unified School District (LAUSD). Food is not cook or prepared at the facility.

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. -----------------PAGE 1
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063
VISIT DATE: 12/02/2022
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and Plans of Corrections were reviewed and developed with Principal. A copy of this report and appeal rights were discussed and left with Principal, Tamara Honegan, whose signature on this form confirm receipt of these documents.

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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
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/02/2022 11:24 AM - It Cannot Be Edited


Created By: Denise Gibbs On 12/02/2022 at 10:55 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: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063

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 showing ALE have been shut off and children do not have access. Per Principal, facility maintenance will be adding filters to the water sources in order to correct the lead exceedance. Maintenance date is still being determined. Principal or Lead Exceedance team will send LPA an email confirming correction by POC date 12/16/22.
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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. LPA observed water sources are inaccessible to children.
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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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