<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014197
Report Date: 03/02/2023
Date Signed: 03/02/2023 11:55:35 AM

Document Has Been Signed on 03/02/2023 11:55 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S BUREAU FAMILY CENTER AT MAGNOLIA PLACEFACILITY NUMBER:
198014197
ADMINISTRATOR:MARY HELEN VASQUEZFACILITY TYPE:
850
ADDRESS:1910 MAGNOLIA AVENUETELEPHONE:
(213) 342-0101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 17DATE:
03/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Paquita Monsorri, Site DirectorTIME COMPLETED:
11:52 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On Thursday, March 2, 2023 at 9:36 a.m., Licensing Program Analysts (LPA's) Mayra Rivera and Rosaura Valenzuela conducted an unannounced case management Lead Testing exceedance inspection. LPA Rivera met with Site Director Paquita Mansouri who guided LPA's on a tour of the facility. There were 17 children and 5 staff present during the inspection.

Analyst Rivera reviewed new Assembly Bill (AB) 2370, Chapter 676, Statues of 2018, which requires the testing of for lead in Child Care Centers (CCCs) with facility Site Director Paquita Mansouri 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 be January 1, 2023, and every 5 years after the date of the first testing.

Facility provided a copy of the report that covers the analysis performed on samples submitted to Clinical Laboratory of San Bernardino on 12/07/22. On 1/25/23, 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 collected on 12/07/2022. drinking faucets reported with 8.6, 14, 6.8, and 11, ppb or greater lead exceedance levels as follows:

Room 307A Bubbler-11
Room 308A Bubbler- 6.8
Room 309A Bubbler-14
Room 310A-bubbler 8.6

Site director Paquita Mansouri informed LPA Rivera that the bubblers/drinking faucet have been removed and covered .Room 305, 306, and 311 are not utilized by the children and not part of the license. LPA observed water filtered pitchers and disposable cups. The facility has corrected the bubblers.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
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)
Page: 1 of 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S BUREAU FAMILY CENTER AT MAGNOLIA PLACE
FACILITY NUMBER: 198014197
VISIT DATE: 03/02/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Site director Paquita stated children drink water from a water filtered pitcher and the items such as fruit and veggies are washed in the kitchenette (which was tested and have passing water levels). A deficiency was cited to ensure that the water faucets noted will not be used as a drinking source or food preparation source for the children.

At approximately 11:11 am., LPA Rivera took pictures of the water faucets sink area (room 307,308, 309, and 310).

The deficiency listed on the following page was observed by the LPA Rivera and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited has been cleared.

The Notice of Site Visit (LIC 9213 –must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview conducted with Site director Paquita Mansouri and a copy of Appeal Rights (LIC 9058) was discussed.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
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)
Page: 2 of 3
Document Has Been Signed on 03/02/2023 11:55 AM - It Cannot Be Edited


Created By: Mayra Rivera On 03/02/2023 at 11:24 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDREN'S BUREAU FAMILY CENTER AT MAGNOLIA PLACE
FACILITY NUMBER: 198014197

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)

1
2
3
4
5
6
7
(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.

(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedence is not met as evidence by:
1
2
3
4
5
6
7
The first week of January 2023, the facility removed the water drinking faucets and covered the bubbler permanately. Facility retested on 2/10/23 and results dated 2/22/23 shows low level 0.75
8
9
10
11
12
13
14
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Karen Chambers
LICENSING EVALUATOR NAME:Mayra Rivera
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)
Page: 3 of 3