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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009834
Report Date: 02/27/2023
Date Signed: 02/27/2023 03:12:49 PM

Document Has Been Signed on 02/27/2023 03:12 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:ANNEX MONTESSORI CHILDCARE CENTERFACILITY NUMBER:
198009834
ADMINISTRATOR:HAYDEE DIAZFACILITY TYPE:
830
ADDRESS:3400 AEROJETTELEPHONE:
(626) 569-2641
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 10TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/27/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Anahi Salinas TIME COMPLETED:
03:30 PM
NARRATIVE
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On 02/27/2023, at 1:30 PM, Licensing Program Analyst (LPA) Roxana Lopez 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 facility Director Anahi Salinas during the visit. Also present in the facility were 4 day care children and 1 teacher. 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 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.

Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA on 02/27/2023. On 12/12/2022, 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 12/01/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:
----------------------------- pg. 1 of 2 --------------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
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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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: ANNEX MONTESSORI CHILDCARE CENTER
FACILITY NUMBER: 198009834
VISIT DATE: 02/27/2023
NARRATIVE
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• Exterior Drinking Fountain- D (6.79 UG/L) – LPA observed drinking fountain to be covered and inaccessible for children in care- picture was taken.

Director stated that the facility has not been using the water fountain since before the pandemic. Children bring water bottles from home and facility has a water jug if needed. The water fountain was covered and secured with a plastic bag when the facility was informed by analyst that it was exceeding acceptable levels. Per Director, water fountain will be replaced and obtain a retest of it afterwards.

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

A copy of PIN 21-21-CCP and appeal rights were provided to facility today

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 and report was reviewed with the facility representative, Director Anahi Salinas ------------------------ pg. 2 of 2 -------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/27/2023 03:12 PM - It Cannot Be Edited


Created By: Roxana Lopez On 02/27/2023 at 02:48 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: ANNEX MONTESSORI CHILDCARE CENTER
FACILITY NUMBER: 198009834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2023
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 me at evidenced by
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During inspection LPA observed the water foutain has been covered and secured with a plastic bag. Per director children are bringing water cups form home and there's a water jug to refill if needed. Director, stated that the water fountain will be replaced and retested.
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Based on ispection, the licensee did not comply with the directive above, as the exterior water fouintain (D) tested with an Action Level Exceedance (ALE) of 6.79. This poses a potential health and safety risk to children in care.
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Once they have have a set date for replacement and retesting Director will inform LPA Lopez.

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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:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023


LIC809 (FAS) - (06/04)
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