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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001757
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:27:42 PM

Document Has Been Signed on 11/04/2022 03:27 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHRIST LUTHERAN INFANT CENTERFACILITY NUMBER:
198001757
ADMINISTRATOR:CLINTON, LISAFACILITY TYPE:
830
ADDRESS:6500 STEARNS ST.TELEPHONE:
(562) 594-6117
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Lisa ClintonTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection on 11/04/2022. LPA Birks met with Lisa Clinton who guided LPA on a tour of the facility. There were 4 infants and two staff present during the inspection.

The purpose of today's inspection is to review and discuss the June 28, 2022 water lead test results received on October 17, 2022. Results indicate that one water source had an action level exceedance of lead. The water fountain on the infant playground had a lead result of 9.40. LPA Birks observed the water fountain and sink fixture was removed and the plumbing capped. Staff indicated that children never used the infant faucet because they drink from bottles and/or sippy cups. The faucet was also not in use due to covid precautions. Director Clinton indicated if there was a need the facility uses bottled water. Note: all other locations which were indicated to have passing water levels).

At approximately 2:30pm LPA Birks took pictures of the capped location during the inspection. A deficiency was cited to ensure that the water faucet noted will not be used as a drinking source unless the plumbing fixture passes future water testing. The deficiency listed was observed to be a potential risk and is being cited in accordance with California Code of Regulations Title 22.

Note: The deficiency was also cleared today as Director Clinton provided a written plan of correction and LPA observed the water fountain was removed (and plumbing capped). Therefore, the citation is cleared today.

Exit interview conducted and report was reviewed with the Director Lisa Clinton. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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Document Has Been Signed on 11/04/2022 03:27 PM - It Cannot Be Edited


Created By: Warren Birks On 11/04/2022 at 02:53 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHRIST LUTHERAN INFANT CENTER
FACILITY NUMBER: 198001757

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
101700.3(b)(1)

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(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 Exceedence
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LPA Birks observed the Director had the playground water fountain removed and plumbing capped. Citation is cleared 11/4/2022.
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This requirement was not met as evidence by record review. Lead test results revealed one water source had an action level exceedence. This is a potential risk to the health and safety of the children in care.

Note: Staff indicated that the fountain was never is use due to Covid protocols.
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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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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