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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018034
Report Date: 03/25/2024
Date Signed: 03/25/2024 02:22:31 PM

Document Has Been Signed on 03/25/2024 02:22 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF HEAD START - LEW SANDS WELTORFACILITY NUMBER:
198018034
ADMINISTRATOR:SONIA GUERREROFACILITY TYPE:
850
ADDRESS:1010 E. 48TH STREETTELEPHONE:
(323) 233-2573
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 72TOTAL ENROLLED CHILDREN: 47CENSUS: 11DATE:
03/25/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Linda RuelasTIME COMPLETED:
02:50 PM
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 03/25/2024, about 1:30PM, Licensing Program Analysts (LPAs) T. Tran and A. Padilla conducted an unannounced case management/Lead inspection at MAOF Lew Sands Weltor Head Start. Upon arrival, LPAs met with Teacher Linda Ruelas and we toured the facility.

The purpose of today's inspection was to go over the water lead test results received on 10/15/22. Results show a water source had action level exceedance of lead. The Toddler's restroom sink had lead exceedance result of 6 ppb. Per facility representative, the source only use for children's hand washing. The area with lead levels action was removed from service and rested on 3/31/23. A deficiency was cited to ensure that the water source 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. Record review indicated last retesting completed on 3/31/23. Citation was 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, Linda Ruelas..

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2024
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 2
Document Has Been Signed on 03/25/2024 02:22 PM - It Cannot Be Edited


Created By: Tiffanie Tran On 03/25/2024 at 01:52 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: MAOF HEAD START - LEW SANDS WELTOR
FACILITY NUMBER: 198018034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2024
Section Cited
CCR
101700.3(b)(1)-(b)

1
2
3
4
5
6
7
Result with values of 5.0 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 one source had an action level exceedance.
1
2
3
4
5
6
7
Facility had provided correction record on 3/31/23 that water source had been replaced with new fixture. That source was only used for children's hand washing.
POC cleared during today's visit.
8
9
10
11
12
13
14
LPA observed EHS children's sink for hand washing sink had been replaced with new fixture.This is a potential risk to the health and safety of the children in care.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2