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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400928
Report Date: 03/19/2025
Date Signed: 03/19/2025 04:18:43 PM

Document Has Been Signed on 03/19/2025 04:18 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:FRUIT OF THE VINE CHILD DEVELOPMENTFACILITY NUMBER:
198400928
ADMINISTRATOR/
DIRECTOR:		SHANIECE SMITHFACILITY TYPE:
830
ADDRESS:12204 S SAN PEDRO STTELEPHONE:
(323) 305-2439
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/19/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:53 PM
MET WITH:Teacher / David SamanoTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On 3/19/25 at 2:50PM, Licensing Program Analysts (LPA) Ashley Calderon and Tyler Reyes conducted unannounced visit to conduct a Case Management Lead Testing Visit for the purpose of obtaining Lead Testing, after the 180 days of being licensed. LPA's met with Teacher David Samano and LPA's disclosed purpose of today's visit.

LPA Calderon via telephonically spoke with Administrator Donna Cunningham and disclosed purpose of the visit. LPA requested Lead testing Results, D.Cunningham emailed LPA Calderon Water Lead Testing Results conducted by Culligan Company, dated 1/16/2025, LPA was provided print copy by Teacher / David Samano.

Per D.Cunningham stated the food preparation and drinking water will be used from the Preschool License Building that the water tested. Per Cunningham stated both buildings on premises was tested. LPAs conducted tour of the Infant Center alongside D.Samano, LPA's observed 0 children in care.

LPA T.Reyes via telephonically spoke with Paul Lee /Water Inspector who informed LPA Reyes they tested the Main Water Line which provides water to the building. LPA's waiting to verification from P.Lee to verify if lead was tested. Lead Sampling Reporting Tool- Water Board Website was reviewed by LPA's A.Calderon and LPA Andrea Carter via telephonically and No sample results were listed under Infant License-1984000928 and Day Care License- 198400257. LPA Caldeorn will review testing results with a Department Manager and will conduct a visit at a further time.

Notice of Site Visit was provided and will be posted for 30 days and exit interview was conducted via telephonically with Administrator Donna Cunningham.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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