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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605714
Report Date: 08/02/2023
Date Signed: 08/02/2023 12:46:42 PM

Document Has Been Signed on 08/02/2023 12:46 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CARMELITOS HEAD STARTFACILITY NUMBER:
191605714
ADMINISTRATOR:MARTHA VILLAFANA & KIRSTENFACILITY TYPE:
850
ADDRESS:5250 VIA PASILLOTELEPHONE:
(310) 428-1926
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 52TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
08/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Faclity RepresentativesTIME COMPLETED:
01:55 PM
NARRATIVE
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On 08/02/2023 at 12:45 PM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management Inspection and met with Keokuk Legarde (ELCM), Maria Harris (Program Administrator), and Blanca Ureta (ELCM). LPA disclosed the purpose of the inspection and was granted entry into the facility and was provided guided tour. Facility is made up of two classrooms RM-1 Early Head Start and RM-2 Preschool.

There was one napping preschooler in RM-2 with three staff present during the inspection. LPA did not observe any children in RM-2 during inspection. Per ELCM, Preschool Program is still on Summer break and not operating.

The purpose of today's inspection was to discuss the water lead test results. Results show that the classroom faucet (F) and drinking fountain (E) in RM-2 that were labeled has action level exceedance (ALE) of lead with results of 9.2 ppb for drinking fountain (F) and 8.04 ppb for classroom faucet (E).

At 12:50 pm, LPA observed and took pictures of the water sources with ALE. LPA tested water fountain in RM-2 which were observed to be inoperable at time of inspection. Per ELCM, faucet in classroom is not used for drinking water or for food preparation. Additionally, LPA did not observe any children in RM-2 as that is for Preschool Program that is still currently closed for Summer. LPA observed water jugs with cups available for drinking water. Per ELCM, parents will be notified pending a letter distributed by LBUSD. Per ELCM, no meals are prepared on site and all meals are delivered by Head Start Kitchen.

A deficiency was cited to ensure that the water sources with the exceedances will not be used as a drinking source or food preparation source for the children.

A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted and report was reviewed with Facility Representatives.
Report Ends - Page 1 of 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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Document Has Been Signed on 08/02/2023 12:46 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/02/2023 at 12:38 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CARMELITOS HEAD START
FACILITY NUMBER: 191605714

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb readings of 0.5 ppb or greater ..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be... Action Level Exceedance. This requirement was not met as evidence by:
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LPA observed drinking fountain with ALE to be turned off at time of inspection and no children where water sources have ALE. LPA observed water jugs available with cups available for drinking water. Clearing deficiency on site.
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Based on record review the Licensee did not ensure water sources at facility to meet lead requirements. Lead test results showed that two water sources has an action level exceedance. This poses a potential health, safety, and personal rights risk to 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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
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