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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018184
Report Date: 08/08/2023
Date Signed: 08/08/2023 10:47:32 AM

Document Has Been Signed on 08/08/2023 10:47 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LBUSD-RILEY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198018184
ADMINISTRATOR:THERESE BASTAFACILITY TYPE:
850
ADDRESS:3319 SANDWOOD STREETTELEPHONE:
(562) 421-2924
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/08/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Fatima Barajas, Coordinating TeacherTIME COMPLETED:
11:00 AM
NARRATIVE
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On 08/08/2023 at 10:15 AM, Licensing Program Analysts (LPAs) Katrina Chicote and Raul Navarro conducted an Unannounced Case Management Inspection and met with Cristabel Rodriguez, Program Coordinator, and Fatima Barajas, Coordinating Teacher. LPAs disclosed the purpose of the inspection and was granted entry into the facility and was provided guided tour. Facility is made up of one classroom in Bungalow 26101 on Riley Elementary School Campus. LPAs did not observe any children present during today's inspection. Facility is currently not operating through the Summer.

The purpose of today's inspection was to discuss the water lead test results. Results show that the classroom drinking fountain, labeled B, to have action level exceedance (ALE) of lead with results of 6.5 ppb. Per Program Coordinator and file review, program has been on inactive status for the 2022-2023 school year but will reopen for the 2023-2024 school year.

At 10:19 AM, LPAs observed and took pictures of the water source with ALE. LPAs tested drinking fountain which was observed to be completely covered and inoperable at time of inspection. Per Coordinating Teacher, children bring their own personal water bottles and are also provided small disposable water bottles for refills or if children forget water bottles. LPA was provided letter distributed to parents by Program Coordinator via email which will be provided to families once the school year begins. Per Coordinating Teacher, no meals are prepared on site and all meals are delivered by LBUSD Central Kitchen.

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

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

Exit interview was conducted and report was reviewed with Facility Representatives.

Report Ends - Page 1 of 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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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Document Has Been Signed on 08/08/2023 10:47 AM - It Cannot Be Edited


Created By: Katrina Chicote On 08/08/2023 at 10:30 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: LBUSD-RILEY CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198018184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb readings of 0.5 ppb or greater ..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be... Action Level Exceedance. This requirement was not met as evidence by:
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LPAs observed drinking fountain with ALE to be made off limits and turned off at time of inspection. Per Coordinating Teacher, drinking fountain will be fixed and re-tested. In the meantime children have personal water bottles for drinking water.
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Based on record review the Licensee did not ensure water source at facility to meet lead requirements. Lead test results showed that one water source has an action level exceedance. This poses a potential health, safety, and personal rights risk to 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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023


LIC809 (FAS) - (06/04)
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