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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018189
Report Date: 08/08/2023
Date Signed: 08/08/2023 12:11:38 PM

Document Has Been Signed on 08/08/2023 12:11 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LBUSD- WEBSTER CDCFACILITY NUMBER:
198018189
ADMINISTRATOR:RANDY SANCHEZFACILITY TYPE:
850
ADDRESS:1740 WEST 34TH WAYTELEPHONE:
(562) 989-1378
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/08/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Facility RepresentativesTIME COMPLETED:
12:25 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 08/08/2023 at 11:15 AM, Licensing Program Analysts (LPAs) Katrina Chicote and Raul Navarro conducted an Unannounced Case Management Inspection and met with Cristabel Rodriguez, Program Coordinator, and Cecilia Verduzco, 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 two classrooms in CDC-1 and CDC-2 on Webster Elementary School campus. LPAs did not observe any children present during today's inspection. Per Program Coordinator, facility is currently not operating through the Summer.

The purpose of today's inspection was to discuss the water lead test results. Results received by RO indicated a water source, labeled B, to have action level exceedance (ALE) of lead with results of 7.46 ppb. Program Coordinator states that they did not receive an ALE result from the Water Sampler. Program Coordinator was on the phone with Water Sampler during inspection, and they stated that there were no ALE results for this facility. Per Program Coordinator and file review, program has been on inactive status for the 2022-2023 school year but will reopen CDC-2 only for the 2023-2024 school year.

LPAs observed and took pictures of various water sources. LPAs tested water fountains (labeled D and F) in outdoor play area which were observed to be inoperable at time of inspection. LPAs tested water fountain in CDC-1 (labeled C) and water fountain (labeled A) in CDC-2 which were observed to both be operable at time of inspection. LPAs did not observe a water source labeled B at time of inspection. LPA was provided letter distributed to parents by Program Coordinator via email which will be provided to families once the school year begins if needed. Per Coordinating Teacher, no meals are prepared on site and all meals are delivered by LBUSD Central Kitchen and water bottles are provided to children for drinking water source.

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)
Page: 1 of 2
Document Has Been Signed on 08/08/2023 12:11 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/08/2023 at 11:41 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- WEBSTER CDC
FACILITY NUMBER: 198018189

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)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
FR states that they were not provided lead test results with ALE. LPAs discussed RO receipt of ALE result. FR states they will communicate with water sampler and appeal deficiency if water sampler confirms no ALE and will update information to RO.
8
9
10
11
12
13
14
Based on record review the Licensee did not ensure water source at facility to meet lead requirements. Lead test results received showed that one water source has an action level exceedance. This poses a potential health, safety, and personal rights risk to 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: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)
Page: 2 of 2