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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020764
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:50:08 PM

Document Has Been Signed on 05/25/2023 01:50 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI OF WALNUTFACILITY NUMBER:
198020764
ADMINISTRATOR:BISHAN SENEVIRATNEFACILITY TYPE:
830
ADDRESS:20121 E. ALISU CTTELEPHONE:
(909) 598-9267
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 18TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/25/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Yesenia Paniagua & Christina GregoryTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jennifer Hua conducted an unannounced case management inspection on 5/25/2023. A COVID 19 risk assessment was conducted. LPA arrived at the facility at 11:52am and met with office assistant Yesenia Paniagua, who provided a tour of the facility. There are 0 infants in care. Director Christina Gregory arrived at 12:10pm. Per director, the infant program has been closed since end of January 2022. The infant classroom #6 has been converted and being used for the preschool program. Director stated will discuss with the owner and submit written request to close out the infant license by 5/30/23. Water Lead testing was conducted under the infant license instead of the preschool license #198013942

The purpose of today's inspection is to go over the water lead test results received on 05/19/2023. Per Director she had not received results of the lead testing. LPA emailed the results to director on 5/24/23. Results indicate that "H” water source had action level exceedance of lead. The "H" water source located in the preschool room #7 had a lead result of 5.5. LPA observed that the faucet is not accessible through sign age with a zip lock bag and tape to make it inaccessible to children in care, as well as staff. Director stated faucet will be repaired or removed. LPA spoke with the Director, who stated that the children bring water from home in their personal drinking container and if children forget, they are provided bottled water and refill their personal drinking container with bottled water as needed. Per Director, ceased using the faucet as soon as results were received on 5/24/23, but previous to that date, children had access. Director emailed LPA the LIC 9275, LIC 9276, Facility Sketch. LPA advised director to review PIN 21-21.1-CCP (Written Directives for Lead Testing of Water).

A deficiency was cited to ensure that the water faucet 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 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.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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 05/25/2023 01:50 PM - It Cannot Be Edited


Created By: Jennifer Hua On 05/25/2023 at 12:52 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI OF WALNUT
FACILITY NUMBER: 198020764

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2023
Section Cited
CCR
101700.3(c)

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California Lead Action Level at Child Care Centers. On 5/19/23, licensee failed to maintain a lead value at or below the Action Level for water lead testing of 5.5 ppb or greater for outlet "H". Result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Per director, outlet has been covered with zip lock bag and appropriate "Out of Use" signage posted around it. Facility will continue to provide LPAs with the status and updates regarding the "H" faucet re-test planned after repair.
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Water testing results identified with Action Level Exceedance as defined in WD section 101700.3 are not deemed safe to drink. This poses an immediate Health and Safety 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:Ana Chico
LICENSING EVALUATOR NAME:Jennifer Hua
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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