191290371-9-1-2023-33-CC-NTCG-CV9TDL-20230901143832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:38:37 PM

Document Has Been Signed on 09/01/2023 02:38 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	JEFFERSON CHILDRENS CENTER		FACILITY NUMBER:	191290371
ADMINISTRATOR:	REE HUDSON		FACILITY TYPE:	850
ADDRESS:	391 NORTH SIERRA BONITA		TELEPHONE:	(626) 796-8845
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 70	CENSUS: 31	DATE:	09/01/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Carolina Arizaga - Site Supervisor		TIME COMPLETED:	03:10 PM

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

Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. This is a follow up visit for an Action Level Exceedance inspection conducted on 08/30/2023. Upon Arrival at 2pm, LPA met with Site Supervisor Carolina Arizaga, who guided LPA on a tour of the facility. There were children present during the time of the inspection.

Census was taken. LPA observed 31 children with 5 staff members

LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA during today’s inspection.

On 08/08/2023, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 08/08/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

· B - Room 5 Water Fountain - 5.87ppb

Site Supervisor states that children do not use the water fountain and that children all bring their own water bottles from home for drinking water. There are disposable water bottles available for children who run out of water or forget to bring a bottle from home. During the inspection LPA observed the affected water outlet to be covered with a plastic bag and taped over in order to prevent access from children in care to drink from it.

REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JEFFERSON CHILDRENS CENTER	FACILITY NUMBER: 191290371
	VISIT DATE: 09/01/2023

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

Although children bring their own water bottles from home, Site Supervisor stated that the fountain was accessible to children in care prior to the Water Sampling.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit

https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Notice of Site Visit was provided and must remain post for 30 consecutive days. A copy of PIN 21-21-CCP and appeal rights were provided to facility today.

An exit interview conducted with Site Supervisor Carolina Arizaga at 2:55pm and a copy of this report was provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 09/01/2023 02:38 PM - It Cannot Be Edited

Created By: Nolan Tcheng On 09/01/2023 at 02:22 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JEFFERSON CHILDRENS CENTER	FACILITY NUMBER: 191290371
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/08/2023 Section Cited CCR 101700.3(b)(1)	1 2 3 4 5 6 7	Testing results with fractional ppb readings of 5.5 ppb or greater shall be rounded up to the nearest whole number...(1) A result with values of 5.5 or greater shall be deemed and Action Level Exceedance. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Per Site Supervisor, they will create a parent memo to place in their Parent Handbook explaining the facility drinking water policy. An invoice for the water bottles delivered every month will be provided to LPA. Water to the affected outlet will be covered with plastic bag and if applicable, will have the
	8 9 10 11 12 13 14	Based on record review and interview, Licensee did not ensure that the water outlet in Room 5, with lead exceedance, was made inaccessible to children in care. This posed a potential risk to the health, safety, and personal rights of children in care.	8 9 10 11 12 13 14	water shut off to the water outlet, pending review and discussion with custodial team. All corrections will be submitted to LPA by POC date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Claudia Guangorena

LICENSING EVALUATOR NAME:

Nolan Tcheng

LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3