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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018117
Report Date: 11/30/2022
Date Signed: 11/30/2022 10:24:47 AM

Document Has Been Signed on 11/30/2022 10:24 AM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:APOLLO CENTERFACILITY NUMBER:
198018117
ADMINISTRATOR:URZUA, CONNIEFACILITY TYPE:
830
ADDRESS:7850QUILL DRIVETELEPHONE:
(562) 861-5857
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 19DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Haydee PortilloTIME COMPLETED:
10:30 AM
NARRATIVE
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On 11/30/2022, about 8:30AM, Licensing Program Analyst (LPA) T. Tran conducted an unannounced case management inspection at Apollo Center. Upon arrival, LPA met with Haydee Portillo, Education Coordinator, and we toured the facility. LPA observed today's census was 7 staff and 19 children.

The purpose of today's inspection was to go over the water lead test results received on 6/30/22. Results show that water fountain source had action level exceedance of lead. The water fountain located on the hallway between two classrooms had a lead result of 6.0 ppb. LPA observed facility had disconnected the water valve to permanently disabled the water fountain. Per facility representative, facility had replaced children water by the use of water dispenser and paper cups. Filtered water was delivered to the site monthly or as needed. A deficiency was cited to ensure that the water fountain 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 LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. On 11/2122, facility had emailed the plan of correction (POC) to permanently disabled the water fountain. POC is 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, Haydee Portillo.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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 11/30/2022 10:24 AM - It Cannot Be Edited


Created By: Tiffanie Tran On 11/30/2022 at 10:04 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: APOLLO CENTER
FACILITY NUMBER: 198018117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited
CCR
101700.3(b)

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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 water fountain source by the hallway between two classrooms had an action level exceedance. This is a potential risk to the health and safety of the children in care.
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On 11/21/22, facility had provided a written statement on their plan to continue to ensure that the water source will not be used as a drinking and was permanently disabled. Facility provide filtered water for the children to drink by the use of water dispenser and paper cups.
POC was cleared during today's visit.

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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:Trevino Cochran
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


LIC809 (FAS) - (06/04)
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