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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400660
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:28:39 PM

Document Has Been Signed on 10/26/2023 03:28 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA OF GLB NIETO HERRERA ELEMENTARYFACILITY NUMBER:
198400660
ADMINISTRATOR:VALENCIA, DIANAFACILITY TYPE:
840
ADDRESS:1620 TEMPLE AVENUETELEPHONE:
(562) 279-1623
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 14DATE:
10/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Diana ValenciaTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an announced case management- Lead Testing/ Exceedance inspection on 10/26/23. LPA met with Site Supervisor Diana Valencia who assisted with the inspection and guided LPA on a tour of the facility. This facility is on the premises of Long Beach Unified School District (LBUSD) Nieto Herrera Elementary. There were 14 children present during today's inspection.
The purpose of today's inspection was to provide a Report with the corrected Visit Type (Case Management - Lead Testing/Exceedance) and to rereview the water lead test results received on August 10, 2023. Lead testing was conducted by LBUSD. Results show that three sources for drinking water that were tested on the facility grounds had an action level exceedance (ALE) of lead of more than 5.5 parts per billion.
The three water sources include two drinking fountains and a water bottle filler station next to the on limits restrooms. During a previous 8/28/2023 inspection LPA J. Estrada indicated the following:

LPA Estrada took photos of the water sources with the ALE. Water sources have been made inaccessible to children in care. Per Senior Program Director Michele Janssen, LBUSD will supply the program with bottled water until the water sources are repaired. Per Senior Program Director, LBUSD has begun repairs on the water sources and will have the water sources re-tested once repairs are complete.
A deficiency was cited to ensure that the water fountains noted will not be used as a drinking source for children in care.

A deficiency was already cited on August 10, 2023 in regards to Title 22 Regulations: 101700.3(b)(1)Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. The deficiency that was cited needs to be cleared to protect the children’s health & safety. There were no citations during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and Appeal Rights and report were reviewed with Site Supervisor Diana Valencia.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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