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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017908
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:03:48 PM

Document Has Been Signed on 07/24/2024 03:03 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:CREATIVE CHILD PRESCHOOLFACILITY NUMBER:
198017908
ADMINISTRATOR/
DIRECTOR:		MICHELLE SYFACILITY TYPE:
850
ADDRESS:1111 OKOBOJITELEPHONE:
(626) 447-6888
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 28DATE:
07/24/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Mchelle Sy - DirectorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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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 2:10pm, 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 28 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 LIC 9276, LIC999 and LIC9275 to LPA during today’s inspection.

On 07/12/2024, 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 11/30/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

· E - Outdoor Water Faucet - Test Result 21ppb

Director states that the faucet was unintentionally tested and that they faucet is not used for any sort of food prep or ingestion by persons at the facility. The water policy for the facility, facility provides filtered water from the kitchen, that has been tested and does not have an exceedance (Water Outlet B) that they use to refill bottles the children bring from home. Cups are available for any child who forgets their water bottle at home.

REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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: CREATIVE CHILD PRESCHOOL
FACILITY NUMBER: 198017908
VISIT DATE: 07/24/2024
NARRATIVE
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As of 02/21/2023, Water Outlet E has been re-sampled and has a test result that is not an Action Level Exceedance. A POC Clearance letter is being provided to the facility on today's date.

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 deficiency listed on the following page were observed by the LPA 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.

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 and a copy of this report was provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/24/2024 03:03 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 07/24/2024 at 02:40 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: CREATIVE CHILD PRESCHOOL
FACILITY NUMBER: 198017908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3 (b)(1)
Testing results with fractional ppb readings of 5.5 ppb or greater shall be rounded up to the nearest whole number...(1) A result with values of 5.5 or greater shall be deemed and Action Level Exceedance.
This requirement is not met as evidenced by:
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Licensee has had Water Outlet E re-sampled on 02/21/2024 and the test result showed no Action Level Exceedance. POC Clearance letter provided on today's date.
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Based on record review and interview, licensee did not ensure that a faucet with an action level exceedance of lead was inaccessible to children, for potential ingestion. This posed a potential risk to the health, safety, and personal rights of 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:Ana Chico
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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