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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000348
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:09:12 PM

Document Has Been Signed on 12/07/2023 03:09 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SAN RAFAEL EARLY CHILDHOOD PROGRAMFACILITY NUMBER:
198000348
ADMINISTRATOR:PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:1090 NITHSDALE, RM #5TELEPHONE:
(626) 793-4189
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
12/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Christian Brambila - Lead TeacherTIME COMPLETED:
03:35 PM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Suzana Safaryan conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. Upon Arrival at 1:30pm, LPAs met with Lead Teacher Christian Brambila, who guided LPA on a tour of the facility. There were children present during the time of the inspection.

Census was taken. LPA observed 11 children with 2 staff members

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 director 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 provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA during today’s inspection.

On 10/17/2023, 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 10/17/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

  • B - Room 5 Custodian Closet - 6.410ppb

LPAs reviewed the closet sink that was sampled on 10/17/2023 and confirmed it was the correct outlet tested. Per Lead Teacher, this sink is only used for mopping and cleaning around the classroom. Eating does not take place in the classroom, but in the Cafeteria of the elementary school

REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SAN RAFAEL EARLY CHILDHOOD PROGRAM
FACILITY NUMBER: 198000348
VISIT DATE: 12/07/2023
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Lead Teacher states children in care are still bringing their own water bottle to class every day and water is filled from filtered water on site if they run out. There are also disposable water bottles on site for children who forget their bottle.

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

The facility is not being cited as none of the faucets with lead exceedance are being used for consumption or food preparation. Due to the children not having access to the Room 4 water outlets, there is no risk to the health, safety, and personal rights of children in care.

Notice of Site Visit was provided and must remain post for 30 consecutive days. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

An exit interview conducted with Lead Teacher Christian Brambila, at 3:15pm, and a copy of this report was provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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