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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400655
Report Date: 01/23/2023
Date Signed: 01/23/2023 10:46:33 AM

Document Has Been Signed on 01/23/2023 10:46 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:KINDERONE PRESCHOOLFACILITY NUMBER:
198400655
ADMINISTRATOR:KANG, YINGJIAOFACILITY TYPE:
850
ADDRESS:19023 NORWALK BLTELEPHONE:
(562) 684-8576
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 65TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
01/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Yingjiao KangTIME COMPLETED:
11:00 AM
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 January 23, 2023 at 9:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Yingjiao Kang. The purpose of the inspection was to conduct a case management inspection for lead testing/exceedance. LPA was provided a tour of the facility by the Director. Per Director, the program was licensed on December 20, 2023 and will start operating on February 1, 2023; therefore, no children were present.

LPA discussed with the Director the water lead test results received on January 2, 2023. The results indicated that a water source in the facility had an Action Level Exceedance (ALE) of lead. The drinking fountain located in the preschool outdoor play yard had a lead result of 9.71 parts per billion (ppb). A result with values of 5.5 parts per billion (ppb) or greater shall be deemed an ALE in accordance with the Lead Testing Written Directives section 101700.3 subsection (b)(1).

Per Director, the drinking fountain has not been used nor will it be used in the future for drinking water or food preparation. The facility will provide children with filtered water for drinking. Per Director, the children can bring their own water bottles which they can fill up with the filtered water. The facility does not prepare meals, children will bring their own lunch from home. Director stated that the facility plans on having the drinking fountain removed prior to the program beginning on February 1st.

LPA took a photograph of the drinking fountain that tested with an ALE in the preschool outdoor play yard. LPA observed the water fountain covered with a plastic bag. LPA also tested the water fountain, which had the water shut off.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERONE PRESCHOOL
FACILITY NUMBER: 198400655
VISIT DATE: 01/23/2023
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
26
27
28
29
30
31
32
A copy of the test results were provided by Director. LPA reminded the Director of the requirement to send photos identifying all water outlets labeled and corresponding to the Facility Sketch (LIC 999) to the LPA as soon as possible, and not later than one week from the date of the Action Level Exceedance notification in accordance with protocol outlined in Written Directives, Section 101703(d).

LPA also discussed and provided copies of the following documents: Provider Information Notice (PIN) 20-01-CCP, PIN 21-04-CCP, PIN 21-21-CCP, PIN 22-06-CCP, and Effects of Lead Exposure Flyer (PUB 515).

No deficiencies were cited during today's inspection. A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Yingjiao Kang.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2