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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416596
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:26:40 PM

Document Has Been Signed on 05/07/2024 01:26 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MAGNOLIA ELEMENTARY SCHOOL CSPPFACILITY NUMBER:
197416596
ADMINISTRATOR/
DIRECTOR:		VELASCO, LUISFACILITY TYPE:
850
ADDRESS:1626 ORCHARD AVENUETELEPHONE:
(213) 748-6281
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY: 72TOTAL ENROLLED CHILDREN: 32CENSUS: 30DATE:
05/07/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Teacher Yesenia Victoria TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in water fixtures in the facility. LPA met with Teacher Yesenia Victoria, during the visit. Census was taken.

LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility representative during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

Facility did provide facility sketch and required forms LIC 9276, LIC 999 and LIC 9275 to the department. Required forms were provided to LPA via email. On 3/04/2024, the Department received notification from the State Water Resources Control Board(SWRCB), Division of Drinking Water (DDW).

The SWRCB report indicated the facility was inspected and samples were collected on 11/16/2022. -Faucets reported with 5.5 ppb or greater lead exceedance levels were as follows:
-------------------------------------------------------------------------pg.1 of 2 -----------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAGNOLIA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416596
VISIT DATE: 05/07/2024
NARRATIVE
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  • Room # 31 Water fountain fixture (A) (159.000 UG/L)
  • Room # 32 Water fountain fixture (B) (400.00 UG/L)

Point- of use- filters were installed on faucets mentioned above- all faucets were re-tested on 12/14/2022. The Department received notification from the State Water Resources Control Board(SWRCB), Division of Drinking Water (DDW) on 2/24/2024 that faucet mentioned above have passed the lead testing- no lead exceedance present.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

See LIC809D for Type B deficiency cited. Deficiency cited today was cleared and planned of correction (POC) letter was given.

A notice of site visit was also provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Vice Principal Erika Moreno ---------------------------- pg 2 of 2 ----------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/07/2024 01:26 PM - It Cannot Be Edited


Created By: Roxana Lopez On 05/07/2024 at 12:41 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAGNOLIA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1)California Lead Action Level at Child Care Centers. (b) Testing results with...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 deemed an Action Level Exceedance. This requirement is not me at evidenced by
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Point- of- use filters were installed on each facuets. Faucets were re-tested on 12/14/2022, passing with no Lead exccedence. The department received results on 2/25/2024.
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Based on ispection, the licensee did not comply with the directive above, as that Sink faucet A and B tested with an Action Level Exceedance (ALE) of 159.000 and 400.000 ppb. This poses a potential health and safety 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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