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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017908
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:32:37 PM

Document Has Been Signed on 02/09/2023 03:32 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:CREATIVE CHILD PRESCHOOLFACILITY NUMBER:
198017908
ADMINISTRATOR:MICHELLE SYFACILITY TYPE:
850
ADDRESS:1111 OKOBOJITELEPHONE:
(626) 447-6888
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 33DATE:
02/09/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Michelle Sy - DirectorTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. Upon Arrival at 2:40pm, LPA met with Director Michelle Sy, who guided LPA on a tour of the facility. There were children present during the time of the inspection.

Census was taken. LPA observed 33 children with 6 staff members.

LPA 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 LIC999 and LIC9275 to LPA during today’s inspection.

On 01/03/2023, 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 01/03/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

  • F - Outside water faucet - Test result is 8.600ppb.

Director states that the water outlet is the outside faucet. It is not used for drinking/consumption or for food preparation. LPA observed the outside faucet (Water Outlet E on sketch) and observed it as a handwashing station for the children in care. Per Director this is not a faucet used for consumption or food preparation. Per Director the water sampling company did not leave any paperwork or reports for the facility. LPA requested they reach out to company during the inspection.

REPORT CONTINUES PAGE 1 of 2
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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: CREATIVE CHILD PRESCHOOL
FACILITY NUMBER: 198017908
VISIT DATE: 02/09/2023
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Facility was notified that the company would be coming back to retest on 02/21/2023 due to the sampler wishing to inspect what part of the faucet is causing the exceedance. Director was able to contact the water company and obtain a Facility Sketch and Self-Certification Form after request. On the Facility Sketch there is no outlet F that is designated. The tested outlets only went up to E. There is no report from the water sampling company that they were providing at the time of inspection.

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

The facility is not being cited as the faucet reported as having an exceedance is not observed during the inspection or on the facility sketch created by the water sampling company.

Notice of Site Visit was provided and must remain post for 30 consecutive days. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

An exit interview conducted with Director Michelle Sy, at 3:25pm and a copy of this report was provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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