<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002033
Report Date: 06/02/2023
Date Signed: 06/02/2023 03:43:17 PM

Document Has Been Signed on 06/02/2023 03:43 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:MARINA MONTESSORI SCHOOLFACILITY NUMBER:
198002033
ADMINISTRATOR:CANDYCE BRIZZOLARAFACILITY TYPE:
850
ADDRESS:2301 XIMENO AVETELEPHONE:
(562) 494-4641
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 18DATE:
06/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Candyce BrizzolaraTIME COMPLETED:
03:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management Lead Testing exceedance inspection on May 9, 2023. LPA Birks met with Director Candyce Brizzolara who guided LPA on a tour of the facility. There were 18 children and four staff present during the inspection.

The purpose of today's inspection is to review and discuss the May 9, 2023 water lead test results received on May 22, 2023. The results indicate that one water source had action level exceedance of lead. The water faucet in the hallway outside classrooms in the hall tested an exceedance of 13.5. Director Brizzolara informed LPA Birks on 5/22/23 that the water fountain has been shut off and will eventually be removed. Director indicated the facility uses filtered water from another source that has passing water levels.

LPA Birks took pictures of the water fountain and observed the fountain to be shut off. A deficiency was cited as the water fountain was accessible prior to testing. This is also to ensure that the water fountain noted will not be used as a drinking source or food preparation source for children (unless the facility submits passing levels).

The deficiency listed on the following page was 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 was cleared on April 4th, 2023 as the accessible fountains were completely removed to protect the children’s health & safety. Therefore, the citation is cleared.

The Notice of Site Visit (LIC 9213 –must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview conducted with Director Jennifer Hollandsworth and a copy of Appeal Rights (LIC 9058) was discussed.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/02/2023 03:43 PM - It Cannot Be Edited


Created By: Warren Birks On 06/02/2023 at 03:25 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: MARINA MONTESSORI SCHOOL
FACILITY NUMBER: 198002033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
1017003(b)(1)

1
2
3
4
5
6
7
(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
1
2
3
4
5
6
7
LPA observed water fountain was shut off. Therefore the item will be cleared as of 5/22/2023 email.
8
9
10
11
12
13
14
This requirement was not met as evidence by record review. Lead test results revealed one accessible water source had an action level exceedence. This is a potential risk to the health and safety of the children in care. LPA Birks observed the water faucet was shut down.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2