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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016689
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:49:09 PM

Document Has Been Signed on 09/17/2024 01:49 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VERMONT AVE. CENTER HEAD STARTFACILITY NUMBER:
198016689
ADMINISTRATOR:JOANNA WILLIAMSFACILITY TYPE:
850
ADDRESS:1435 W. 27TH STREETTELEPHONE:
2133212215
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: DATE:
09/17/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Debbie GipsonTIME COMPLETED:
01:40 PM
NARRATIVE
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On 9/17/2024, about 12:30PM, Licensing Program Analysts (LPAs) T. Tran and A. Calderon conducted an unannounced case management inspection for Lead Testing at Vermont Center Head Start. Upon arrival, LPA met with Debbie Gipson, Site Supervisor and we toured the facility. LPAs observed proper care and supervision.

The purpose of today's inspection was to go over the water lead test results received on 05/14/24. Results show that a water source had action level exceedance of lead. The storage sink located in room 03/class 02 had a lead result of 9.7. LPAs observed that sink was tapped off with trash bag and inaccessible to children. Per facility representative, children drinking source is currently use by filtered water dispenser and disposable cups.

A deficiency was cited to ensure that the water faucet noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were observed by the LPAs 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 needs to be cleared to protect the children’s health & safety. Plan of correction has been cleared during today's visit.

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

Exit interview conducted and report was reviewed with the facility representative, Debbie Gipson..

SUPERVISORS NAME: Sharon Greene
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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Document Has Been Signed on 09/17/2024 01:49 PM - It Cannot Be Edited


Created By: Tiffanie Tran On 09/17/2024 at 01:27 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VERMONT AVE. CENTER HEAD START
FACILITY NUMBER: 198016689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2024
Section Cited
CCR
101700.3(b)(1)

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Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement was not met as evidence by record review. Lead test results showed that the storage sink in room3/class2 had lead exceedance of 9.7. LPAs observed the water souce was tapped off with trash bag
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POC- On 9/17/24, facility had provided a written statement on their plan to continue to ensure that the water source will not be used as a drinking or food preparation source. Children do not have access to the storage where lead exceedance was observed.
POC is cleared during today's visit.
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inaccessible to children in care. This is a potential risk to the health and safety of the 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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024


LIC809 (FAS) - (06/04)
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