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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009398
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:21:02 PM

Document Has Been Signed on 12/03/2024 01:21 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. BARNABAS PRESCHOOLFACILITY NUMBER:
198009398
ADMINISTRATOR/
DIRECTOR:		PATRICIA JOHNSONFACILITY TYPE:
850
ADDRESS:1130 MARSHALL PLTELEPHONE:
(562) 988-8481
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 12DATE:
12/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Acting Director- Suzanne WrenTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On December 2, 2024 at 12:15p.m., Licensing Program Analysts (LPAs) Keneisha Dunlap and Jeanette Estrada arrived at the above facility for the purpose of an unannounced Case Management visit. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Acting Director- Suzanne Wren. There were 15 children enrolled, 12 children present, and 2 staff present at the time of visit.

Acting Director- Suzanne provided LPA Dunlap with paperwork that the facility has an upcoming visit on December 6, for Lead Testing. Acting Director stated that they tried to apply for a grant and was unable to obtain funding. Therefore, prolonging the testing in order to find someone by the POC date that was cited in 809D on 10//22/24 by LPA Dunlap.

LPA Dunlap provided the following paperwork to the facility to ensure that they turn in the proper documents for testing.

LIC 9276

LIC9275

LIC 9099 (2 copies)

LPA Dunlap explained LIC 9275 & LIC 9276 to facility.

LPA Dunlap informed the facility that the LIC999 provided did not designate each water outlets on the map prior the scheduled water sampling appointment, each water outlet to be tested must labeled using the lettering system A-Z. The water labels must be labeled large enough to be photographed by the sampler. If there are more than 26 outlets, used after A through Z, the lettering must go from Z to AA, BB, CC, DD, etc. and must be re done prior to testing.

LPA Dunlap informed facility that they must provide copies of the above forms as well as the lead test results on or before January 3, 2025.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398
VISIT DATE: 12/03/2024
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LPA Dunlap informed the facility that if there is a lead exceedance for the sink that children use to wash their hands, the facility must have a plan of correcting and/or alternative plan for children to wash their hands at a sink that does not lead.

LPA Dunlap informed facility that they must adhere to the PIN 21-21.

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

Exit interview conducted and report was reviewed with the Acting Director- Suzanne Wren.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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