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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002619
Report Date: 10/12/2022
Date Signed: 10/12/2022 03:54:41 PM

Document Has Been Signed on 10/12/2022 03:54 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:YMCA GLB CREATIVE BEGINNINGS PRESCHOOLFACILITY NUMBER:
198002619
ADMINISTRATOR:NICOLAS ARAYAFACILITY TYPE:
850
ADDRESS:5600 LINDEN AVE.TELEPHONE:
(562) 422-2616
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 12DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Director - Angie OronaTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management inspection on 10/12/22. LPA arrived at the facility at 2:20 PM and was met with eligibility clerk, Nancy Robles, who guided analyst on a tour of the facility. Director Angie Orona met with LPA at 3:00 PM and took over tour. There were 12 children and 8 staff members present during the inspection.

The purpose of today's inspection was to go over the water lead test results received on 10/07/22. Results show that one water source had action level exceedence of lead. The water fountain/faucet located outside had a lead result of 6.8. LPA observed that the water fountain/faucet was covered with plastic making it inaccessible to children. LPA spoke to Director who stated that drinking water is provided by a third party provider. Water provided by a third party is used to fill jugs for drinking water in each classroom and for the outdoor play area. LPA observed several 5 gallon water jugs stored in the facility break room. LPA took pictures of the water fountain/faucet during inspection. A deficiency was cited to ensure that the water fountain/faucet noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were observed by the LPA andis being cited in accordance with California Code of Regulation Title 22. Please see attached LIC809-D. The deficiency that is being cited needs to be cleared to protect the children's health and safety.

Exit interview conducted and report was reviewed with the Director Angie Orona. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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 10/12/2022 03:54 PM - It Cannot Be Edited


Created By: Randy Derraco On 10/12/2022 at 03:34 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: YMCA GLB CREATIVE BEGINNINGS PRESCHOOL
FACILITY NUMBER: 198002619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2022
Section Cited
CCR
101700.3(b)(1)

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(b) Testing results with fractional ppb readings of .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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The facility will provide a written statemnt on their plan to continue to ensure that the water sources will not be used as a drinking or food preparation source by POC date 11/02/22
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This requirement was not met as evidence by record review. Lead test results showed that one water source had an action level of exceedence. LPA Derraco observed the water fountain/faucent to be made inaccessible with a plastic bag
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This is a potential risk to the health and safety of the 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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022


LIC809 (FAS) - (06/04)
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