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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817393
Report Date: 09/19/2023
Date Signed: 09/29/2023 11:05:35 AM

Document Has Been Signed on 09/29/2023 11:05 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EASTER SEALS CHILD DEVELOPMENT CENTER-ONTARIOFACILITY NUMBER:
364817393
ADMINISTRATOR:ANNA CRUZFACILITY TYPE:
850
ADDRESS:2999 S. HAVEN AVETELEPHONE:
(909) 923-3352
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: DATE:
09/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Director Anna CruzTIME COMPLETED:
05:43 PM
NARRATIVE
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**************************THIS REPORT WAS CREATED IN ERROR********************************

PLEASE REFER TO FACILITY NUMBER 364817394 EASTER SEALS CHILD DEVELOPMENT CENTER, LIC809 CASE MANAGEMENT - LEAD TESTING/EXCEEDANCE CONDUCTED ON 09/19/2023.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EASTER SEALS CHILD DEVELOPMENT CENTER-ONTARIO
FACILITY NUMBER: 364817393
VISIT DATE: 09/19/2023
NARRATIVE
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**************************THIS REPORT WAS CREATED IN ERROR********************************
PLEASE REFER TO FACILITY NUMBER 364817394 EASTER SEALS CHILD DEVELOPMENT CENTER, LIC809C, CASE MANAGEMENT - LEAD TESTING/EXCEEDANCE CONDUCTED ON 09/19/2023.

Additionally, the following resources were discussed and provided from PIN 21-21-CCP dated July 28, 2021:
101700.6 Grant Funding for Qualifying Child care Centers

(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:

(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.

(2) Those that have 50 percent or more of their registered children who receive subsidized care.

(3) Those that operate only one facility.

(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.

(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

An exit interview was conducted, and appeal rights discussed.

LPA S. Brewer provided Director Anna Cruz, with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for three years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2023 11:10 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/20/2023 04:16 PM


Created By: Susan Brewer On 09/19/2023 at 05:53 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: EASTER SEALS CHILD DEVELOPMENT CENTER-ONTARIO
FACILITY NUMBER: 364817393

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2023
Section Cited
CCR
101700.3(b)(1)

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THIS REPORT WAS CREATED IN ERROR; REFER TO FACILITY NO. 364817394 EASTER SEALS CCC, LIC809D, A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:
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Facility will implement corrective action pursuant to section CCR 101704 for immediate cessation of outlets testing with action level exceedance until it is replaced and retested pursuant to section CCR 101705 and returns a result at or below the Acton level.
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Based on records review of required lead testing, the facility had lead values of 5.5 or above on water outlet M, left kitchen sink resulted in 6.0 ppb, which is a potential health and safety risk to persons in care.
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Facility will notify CDSS with completion within 30 days.

NOTE: THIS REPORT WAS CREATED IN ERROR; REFER TO FACILITY NO. 364817394 EASTER SEALS CCC, FOR PLAN OF CORRECTION.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


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