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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006261
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:47:01 AM

Document Has Been Signed on 06/22/2023 11:47 AM - 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:VAN WIG HEAD START/STATE PRESCHOOLFACILITY NUMBER:
198006261
ADMINISTRATOR:JOANNE MENDEZFACILITY TYPE:
850
ADDRESS:1151 VAN WIG AVE.TELEPHONE:
(626) 931-8000
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rosie DucoingTIME COMPLETED:
12:00 PM
NARRATIVE
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On 06/22/2023, at 9:30 AM, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced case management lead testing exceedance inspection for an Action Level Exceedance (ALE) detected in three water fixtures in the facility. LPA called and spoke to Child Development Education Supervisor, Yolanda Orozco as the facility is closed for summer break from June 6- August 14, 2023. At approximately 9:45 am Child Development Director, Rosie Ducoing met LPA at the facility to let her in and conduct the Lead inspection. A Covid 19 risk assessment was conducted. There was a census of zero (0) children in care and there were no staff present during the inspection. LPA then drove over to the Flanner Head Start Preschool (191570934) facility located 2 minutes away to complete the report and acquire documentation from the Director.

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 the 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.

Director provided facility sketch; all outlets tested were labeled with a “Do Not Use” signage and covered. In addition, required forms LIC 9276, and LIC 9275 were given to LPA during the visit. LPA took photos as well as the Director providing photos. According to the Director faucets have been flushed and aerators cleaned and retested. Per Director she received results that were below exceedance, but is waiting for formal report.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
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: VAN WIG HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 198006261
VISIT DATE: 06/22/2023
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On 01/05/2023, 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 10/07/2022. There were three (3) sinks/faucets reported with 5.5 ppb or greater lead exceedance levels were as follows:

Sample Site J - Sink Faucet inside children’s bathroom located between Room I and H (4700 UG/L)
Sample Site E – Sink Faucet small children’s combined sink located in Room H (5.9 UG/L)
Sample Site F – Sink Faucet small children’s combined sink located in Room H (6.2 UG/L)

Sinks are currently not in use due to summer break (June 6, - August 14, 2023) and signage until Director receives the formal report of 5.5 ppb or lower exceedance. Facility is part of a school district and per Director, testing needs to be coordinated with District’s Maintenance Department.

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 Child Development Director, Rosie Ducoing. Along with appeal rights were provided.

A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/22/2023 11:47 AM - It Cannot Be Edited


Created By: Carolyn Tuba On 06/22/2023 at 10:58 AM
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: VAN WIG HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 198006261

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2023
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 the facility is not using due to summer closure and Room H is not operational. The facility has put an "out of service" sign on and covered faucets J, E & F with plastic bag around the outlets making them inaccessible to children. Per Director faucets have been flushed and aerators
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Based on record review, the licensee did not comply with the directive above, as three outlets out of fourteen outlets tested with an Action Level Exceedance (ALE). This poses a potential Health and Safety risk to children in care.
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cleaned and has been retested. Director will continue to provide the status and updates regarding the formal report for the outlets that had been retested. Director will email LPA report within 30 days by 07/21/23.

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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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


LIC809 (FAS) - (06/04)
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