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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002668
Report Date: 08/08/2023
Date Signed: 08/08/2023 04:02:01 PM

Document Has Been Signed on 08/08/2023 04:02 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LBUSD-WILLARD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198002668
ADMINISTRATOR:RESHON MOUTRAFACILITY TYPE:
850
ADDRESS:1055 FREEMAN AVENUETELEPHONE:
(562) 987-1926
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 47TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/08/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Facility RepresentativesTIME COMPLETED:
04:00 PM
NARRATIVE
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On 08/08/2023 at 3:00 PM, Licensing Program Analysts (LPAs) Katrina Chicote and Raul Navarro conducted an Unannounced Case Management Inspection and met with Program Coordinator, Cristabel Rodriguez, and Tiffany Sanchez, Coordinating Teacher. LPAs disclosed the purpose of the inspection and was granted entry into the facility and was provided a guided tour. Facility operates two rooms: RM-1 and RM-4 located on Willard Elementary School campus. LPAs did not observe any children in care at time of inspection. Per Program Coordinator, facility is currently not operating through the Summer.

The purpose of today's inspection was to discuss the water lead test results. Results show that water source, labeled E, has action level exceedance (ALE) of lead with results of 8.49 ppb.

At 3:05 PM. LPAs observed and took pictures of the water source with ALE which is a faucet located in RM-1. Per Coordinating Teacher, this faucet is not used for drinking water or food preparation though District Maintenance tested all water sources. Per Coordinating Teacher, no meals are prepared on site and all meals are delivered by LBUSD Central Kitchen. Per Coordinating Teacher, children are provided personal water bottles as source of drinking water.

A deficiency was cited to ensure that the water source with the exceedance will not be used as a drinking source or food preparation source for the children.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Facility Representatives.


Report Ends - Page 1 of 1

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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 08/08/2023 04:02 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/08/2023 at 03:00 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: LBUSD-WILLARD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198002668

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb readings of 0.5 ppb or greater ..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be... Action Level Exceedance. This requirement was not met as evidence by:
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LPAs observed water source has been completely removed during inspection. LPAs did not observe children during inspection. Per FR, facility is currently replacing pipes and fixture and will re-test water source and provide results to LPA by POC date.
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Based on record review the Licensee did not ensure water source at facility to meet lead requirements. Lead test results showed that one water source has an action level exceedance. This poses a potential health, safety, and personal rights risk to 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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023


LIC809 (FAS) - (06/04)
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