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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015485
Report Date: 03/01/2024
Date Signed: 03/01/2024 12:21:00 PM

Document Has Been Signed on 03/01/2024 12:21 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:OAK TREE DAY SCHOOLFACILITY NUMBER:
198015485
ADMINISTRATOR:GASSIA KRIKORIANFACILITY TYPE:
830
ADDRESS:456 W. ORANGE GROVE AVENUETELEPHONE:
(909) 620-1200
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
03/01/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Site Supervisor Sara KrikorianTIME COMPLETED:
12:40 PM
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On 03/01/2024, at 9:45 AM, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with facility Site Supervisor, Sara Krikorian, during the visit. Also present in the facility were 0 day care children and 1 teachers/staff. Facility was within ratio & capacity. A Covid risk assessment was conducted prior to entering the facility.

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 03/01/24.

On 08/23/2022, 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 07/29/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

A – Sink Faucet In Facility Lounge (20.000 UG/L) – Faucet currently not in use. Director stated that the lounge has not been in used since before Covid and has been used as a storage ever since. LPA observed that the room was used as storage with supplies in it. Facility has put an "out of order/do not use" sign on and around the facility lounge faucet and made it further inaccessible by attaching and securing a plastic bag around the outlet. Ms. Krikorian stated that she will have the faucet replaced and obtain a retest of it afterwards.

See LIC809C for continuation…
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: OAK TREE DAY SCHOOL
FACILITY NUMBER: 198015485
VISIT DATE: 03/01/2024
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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.

Exit interview conducted and report was reviewed with the facility representative, Site Supervisor Sara Krikorian. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/01/2024 12:21 PM - It Cannot Be Edited


Created By: Stephanie Li On 03/01/2024 at 11:55 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: OAK TREE DAY SCHOOL
FACILITY NUMBER: 198015485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
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...to the Action Level. (1) A result with values of 5.5 ppb or greater deemed an Action Level Exceedance.
This requirement is not met as evidenced by:
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Facility has replaced both outlets and will obtain a retest for A outlet. Site supervisor will email LPA proof of retest appointment by 3/15/24.
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Based on record review, the licensee did not comply with the directive above, as two outlet (water fountain located outdoor in front of preschool entrance,not used) out of three outlets tested with an Action Level Exceedance (ALE). This poses an immediate 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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
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