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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371573
Report Date: 12/16/2022
Date Signed: 12/16/2022 01:07:55 PM

Document Has Been Signed on 12/16/2022 01:07 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CARL E. GILBERT PRESCHOOLFACILITY NUMBER:
304371573
ADMINISTRATOR:RAMIREZ, LESLIEFACILITY TYPE:
850
ADDRESS:7255 8TH STREETTELEPHONE:
(714) 522-7281
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 24TOTAL ENROLLED CHILDREN: 30CENSUS: 13DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Desiree Spencer, Lead TeacherTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced Case Management visit. LPA met with Desiree Spencer, Lead Teacher, to discuss the Lead Sampling Testing conducted on 11/10/2022. LPA confirmed that Director had posted the Lead Sample Report.

Lead Teacher stated the outlets with the high level of Lead was located in the classrooms. During today’s inspection, LPA Torrence observed the outlet inoperable, as the outlets are turned off and taped, with "Out of Service" signed above them. Source of drinking water is available by the children bringing their own water bottles from home, labeled with their names. Source of water used for washing hands and material is provided by portable sinks.

Exit interview conducted and report was reviewed with the facility representative Desiree Spencer. A notice of site visit was given and must remain posted for 30 days.



Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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 12/16/2022 01:07 PM - It Cannot Be Edited


Created By: Stacy Torrence On 12/16/2022 at 12:45 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CARL E. GILBERT PRESCHOOL
FACILITY NUMBER: 304371573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited

101700.3(b)(1)

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101700.3(b)(1) California Lead Action Level of Child Care Centers. (b) Testing results with fractional ppb readings of 0.5 ppb or greater ……. (1) shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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Facility has turned of the outlets and taped up.and a "Out of Service" sign over the outlet.
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 Based on facility Lead sampling testing it was discovered that three outlets located in the classroom had a high level of lead. This poses a potential risk to the health of 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:Thuy Ho
LICENSING EVALUATOR NAME:Stacy Torrence
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022


LIC809 (FAS) - (06/04)
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