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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003049
Report Date: 03/02/2023
Date Signed: 03/02/2023 04:14:06 PM

Document Has Been Signed on 03/02/2023 04:14 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:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198003049
ADMINISTRATOR:OLMOS, JAYLEENFACILITY TYPE:
850
ADDRESS:4514 LARK ELLENTELEPHONE:
(626) 332-4001
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 44DATE:
03/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jayleen OlmosTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with facility director, Jayleen Olmos who guided LPA on a tour of the facility.A COVID 19 risk assessment was conducted prior to entering the facility.

LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of
water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

On 10/27/2022, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 10/08/2022. Faucet reported with 5.5 ppb or greater lead exceedance levels were as follows:

 C – Drinking Fountain inside Preschool Classroom #1 (6.0 UG/L) Faucet currently not in use.
 E – Drinking Fountain inside Preschool Classroom #2 (7.4 UG/L) Faucet currently not in use.
 H – Drinking Fountain inside Preschool Classroom #3 (5.7 UG/L) Faucet currently not in use.

Director stated that 3 outlets (2 indoor drinking fountain one in room #2 and 1 in room #3 & 1 hand washing outlet in room #1) were used by children and children would bring their own drinking labeled cups or the school would provide water bottles. The faucet’s use was terminated when the facility was informed by the analyst that it was exceeding acceptable levels.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003049
VISIT DATE: 03/02/2023
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Facility has put a "Do not use" sign on the outlets mouth piece (Photo provided) as well as taped it off all around the mouth piece. Jayleen also stated that no children were using the 2 drinking outlets due to covid and that they had the water off on those outlets. Jayleen stated that she had the faucets replaced and will obtain a retest of it afterwards.

The facility replace the fixture and the facility utilize the new fixture flushing tracking sheet and documented the 30 second flush, 4 times each day for 3 weeks and then have already requested a re-schedule of the lead retest date. Facility will notify the Department of the completion date.

The facility provided a copy of the facility sketch and required forms LIC 9276, LIC999 and LIC9275 to case LPA Thelma by email on 11/04/2022 and handed LPA Reyes the same documents on this date. LPA took a picture of the drinking faucet on this date.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

See LIC809D for Type B deficiency cited.

Exit interview conducted and report was reviewed with the facility representative, Director, Jayleen Olmos. A copy of PIN 21-21-CCP and appeal rights were provided to the Director on this date. A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2023 04:14 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 03/02/2023 at 01:47 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...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 deemed an Action Level Exceedance. This requirement is not met as evidenced by
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Director stated outlets were removed from service immediately when exceedance was determined. Parents were notified and test results were posted visible for all. Alternate drinking water sources were provided to children. Fixtures removed and replaced. Re-testing of new outlets began and
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Based on record review, the licensee did not comply with the directive above, as 3 outlets (2 indoor drinking fountain & 1 hand washing outlet) out of 13 outlets tested with an Action Level Exceedance (ALE). This poses/posed a potential health, safety or personal rights risk to persons in care.
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documented each day for 3 weeks and then will re-schedule the lead retest date. The facility will provide a written statement on the time line of the fixtures removed, replaced, re-tested, documented and retest date of new fixtures and outcome.

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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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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