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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000854
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:20:41 PM

Document Has Been Signed on 03/14/2024 12:20 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:LA PETITE ACADEMY INC.-GRAND AVE.FACILITY NUMBER:
198000854
ADMINISTRATOR:KAMAL GUPTAFACILITY TYPE:
840
ADDRESS:722 SO. GRAND AVE.TELEPHONE:
(909) 860-4009
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: DATE:
03/14/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Kamal GuptaTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced case management inspection . LPA met with Director Kamal Gupta, the purpose of the visit was announced.

The purpose of today's inspection is to go over the water lead test results received on 8/28/2022. Results indicate that the faucet had action level exceedance of lead. The faucet located in the kitchen had a lead result of 11.1 ppb. LPA observed the faucet located in the kitchen has been replaced. Per director,the faucet on the little sink in the kitchen has never been used for water consumption or food preparation source. The faucet in the big (main) kitchen sink is the only use for food preparation source. Copy of LIC 9276, LIC 9275, the facility sketch, photo to show that faucet has been replaced, photo of the main sink in the kitchen have been received.



Based on above, deficiency cited on attached 809D.


Exit interview conducted and report was reviewed with the Facility Representative Kamal Gupta. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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Document Has Been Signed on 03/14/2024 12:20 PM - It Cannot Be Edited


Created By: Jennifer Hua On 03/14/2024 at 11:44 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: LA PETITE ACADEMY INC.-GRAND AVE.
FACILITY NUMBER: 198000854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
101700.3(c)

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California Lead Action Level at Child Care Centers. Licensee failed to maintain a lead value at or below the Action Level for water lead testing of 5.5 ppb or greater for outlet F. Result with values of 5.5 ppb or greater shall be deemed an Action Level
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Per director, outlet was retested and analytical results indicated it's below the action level. Copy of documentation provided during visit.

Deficiency has been corrected.
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his requirement is not met as evidenced by: Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink. This poses an potential Health and Safety risk
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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:Ana Chico
LICENSING EVALUATOR NAME:Jennifer Hua
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024


LIC809 (FAS) - (06/04)
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