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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004054
Report Date: 10/27/2023
Date Signed: 10/27/2023 04:50:54 PM

Document Has Been Signed on 10/27/2023 04:50 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WASHINGTON ACCELERATED SCHOOL ECPFACILITY NUMBER:
198004054
ADMINISTRATOR:PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:1520 N. RAYMOND AVE.TELEPHONE:
(626) 791-4573
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 25DATE:
10/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Rina Giron, Site SupervisorTIME COMPLETED:
03:10 PM
NARRATIVE
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On 10/27/2023 at 12:01PM, Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Case Management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. A COVID 19 risk assessment was conducted prior to entering the facility. LPA met with site supervisor Rina Giron during the visit. Per Ms. Giron, there were 25 day care children, 2 teachers and 4 aides. Facility was within ratio & capacity.

Analyst 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 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.

Facility sketch and required forms LIC 9275, LIC9276 and LIC999 was received by the Department during this inspection. On 10/26/23, 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. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels was as follows:
  • Water Faucet - A (6.934 UG/L) – Based on the sketch provided, LPA observed the water faucet is located in room B108. Per Ms. Giron, it is being used by staff for washing hands, staff lunch dishes, painting brushes used used in children's activity. She stated it was never been used for drinking or food prep purposes. During this visit, Ms. Giron covered the faucet with plastic bag and placed a do not use sign - picture was taken. Lead testing results from the lab was not available at this time.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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Document Has Been Signed on 10/27/2023 04:50 PM - It Cannot Be Edited


Created By: Thelma Razo On 10/27/2023 at 12:13 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: WASHINGTON ACCELERATED SCHOOL ECP
FACILITY NUMBER: 198004054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers. (b) Testing results with fractional readings of parts per billion (ppb) 0.5 ppb or greater shall be rounded before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Fixtures with lead exceedance were made inaccessible to further use by bagging the fixtures and by placing a Do Not Use sign. Site supervisor stated that the faucets will be retested and results will be submitted to LPA
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This requirement is not me at evidenced by Based on inspection and available information at the time of visit, the licensee did not comply with the directive above. Water faucet A, fountain C and D were tested and results showed an Action Level Exceedance (ALE) of 6.934, 11.1 and 8.61 respectively. This poses a potential health and safety 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Thelma Razo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON ACCELERATED SCHOOL ECP
FACILITY NUMBER: 198004054
VISIT DATE: 10/27/2023
NARRATIVE
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  • Drinking Fountain - C (11.1 UG/L) – Based on the sketch provided, LPA observed the water faucet is located outside of B106 and B108 by Grandview Playground. It was bagged and a do not use sign was placed by site supervisor. Picture was taken.
  • Drinking Fountain - D (8.61 UG/L) – Based on the sketch provided, LPA observed the water faucet is located outside of B106 and B108 by Grandview Playground. It was bagged and a do not use sign was placed by site supervisor. Picture was taken.

Site supervisor stated that meals are prepared in the cafeteria from the adjacent building within the campus. Facility uses disposable plates and utensils, and utilizes water bottles for drinking. Picture was taken.

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.

A notice of site visit was also provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted. Appeal rights and report was provided to site supervisor Rina Giron.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
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