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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000348
Report Date: 02/23/2024
Date Signed: 02/23/2024 11:59:54 AM

Document Has Been Signed on 02/23/2024 11:59 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
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: 0DATE:
02/23/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Christian Brambila - Lead TeacherTIME COMPLETED:
12:15 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 11:25pm, LPA met with Lead Teacher Christian Brambila, who guided LPAs on a tour of the facility. There were children present during the time of the inspection.

Census was taken. LPAs observed 0 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 08/08/2023 and 10/01/2023, 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 08/08/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

  • A - Water Outlet Room 4 - 5.91ppb - 08/08/2023
  • A30 - Water Outlet Room 4 - 7.06ppb - 08/08/2023
  • B -Water Outlet Room 4 Maintenance - 20.2ppb - 08/08/2023
  • B - Room 5 Custodian Closet faucet - 6.410ppb - 10/01/2023

REPORT CONTINUES PAGE 1 of 2
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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
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: 02/23/2024
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Lead Teacher stated that the licensed classroom for the facility is only Room 5. Room 4 is used only by San Rafael Elementary School that the facility is at. Lead Teacher states that the children for the preschool program only use Room 5 and do not have access to Room 4 or the maintenance room in Room 4. The Room 5 maintenance closet is unlocked and accessible to children in care. Due to the the lock on the doorknob, the teacher is not able to receive a copy of the key at this time. Lead Teacher states the school will provide a safety handle cover to make the room inaccessible to children in care Lead teacher explained that the drinking water policy is to have children bring their own bottles from home, and a filter outlet is available for children to refill their bottles. Disposable bottles are available for children who forget their bottles.

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 deficiency listed on the following page were 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.

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 12:00pm, 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: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/23/2024 11:59 AM - It Cannot Be Edited


Created By: Nolan Tcheng On 02/23/2024 at 11:39 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SAN RAFAEL EARLY CHILDHOOD PROGRAM
FACILITY NUMBER: 198000348

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/01/2024
Section Cited
CCR
101700.3(b)(1)

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Testing results with fractional ppb readings of 5.5 ppb or greater shall be rounded up to the nearest whole number...(1) A result with values of 5.5 or greater shall be deemed and Action Level Exceedance

This requirement is not met as evidenced by:
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Per Licensee, they will obtain a safety cover for the doorknob to the Room 5 maintenance room. Lead Teacher will communicate with Pasadena Unified School District Coordinator. Proof of correction will be submitted by POC date.
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Based on interview, record review, and observation, the licensee did not ensure that water outlets with lead exceedances, were in accessible to children in care. This poses a potential risk to the health, safety, and personal rights of 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024


LIC809 (FAS) - (06/04)
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