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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191802051
Report Date: 03/01/2023
Date Signed: 03/01/2023 10:18:34 AM

Document Has Been Signed on 03/01/2023 10:18 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SALVATION ARMY DAY CARE CTRFACILITY NUMBER:
191802051
ADMINISTRATOR:MARIA RODRIGUEZFACILITY TYPE:
850
ADDRESS:836 STANFORD AVETELEPHONE:
(213) 623-9022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90021
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 63DATE:
03/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maria Rodriguez, TIME COMPLETED:
10:35 AM
NARRATIVE
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On March 1, 2023, at 8:45AM., Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced case management inspection and met with Maria Rodriguez, Director. This is a preschool program with Toddler Option. The Toddler Option is currently not in service due to the refurbishment of rooms. The Preschool program consists of 8 open classrooms. The hours of operation are Monday through Friday – 7:30am to 4:30pm. There were 63 children and 11 staff present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that 5 water sources have action level exceedance (ALE) of lead: Room #1 – Sink Faucet used for drinking water have a lead exceedance of 19.6 points per billion (ppb), Room #2 – Sink Faucet used for drinking water have lead exceedance of 12.2 points per billion (ppb), Room #8 – Sink Faucet used for drinking water have a lead exceedance of 10.1 parts per billion (ppb), Room #8 – Sink Faucet used for drinking water have lead exceedance of 5.96 parts per billion (ppb), and Outside Playground Fountain – 25.1 parts per billion (ppb); fountain has not been used for over 13 years and is off-limits area of a split playground with a fence. The area does have future for refurbishment with no date planned. (LPA took photos of all five areas). LPA observed signs posted stating out of service-do not use.

At 9:30a.m., LPA observed and tested all water sources with ALE. Water sources were observed to be turned off and inaccessible to children. LPA observed pitchers of water and cups in each classroom and is readily available to children. The water comes from a filtered water machine. LPA reminded Director that lead results must be posted where they are accessible to parents. In addition to posting the lead results on the parent board, located in entry way, the center sent a letter out to all parents on 11/23/22 regarding the lead testing results and correction process. Lead exceedance team is scheduled to repair all areas on March 2, 2023 by replacing the whole sink and installing filters to the affected water sources. A deficiency was cited to ensure that the water faucets with the exceedance will not be used as a drinking source or food preparation source for the children. The center has a kitchen and does prepare but the water sources were tested and not over lead
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SALVATION ARMY DAY CARE CTR
FACILITY NUMBER: 191802051
VISIT DATE: 03/01/2023
NARRATIVE
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exceedance levels.
The deficiency listed on the following page was 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 by 03/15/2023 to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and the Plan of Correction was reviewed and developed with the Director. A copy of this report and appeal rights were discussed and provided to Director Maria Rodriguez, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/01/2023 10:18 AM - It Cannot Be Edited


Created By: Dayna Chambers On 03/01/2023 at 10:02 AM
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: SALVATION ARMY DAY CARE CTR
FACILITY NUMBER: 191802051

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2023
Section Cited
CCR
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 shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidence by:
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Water sources showing ALE have been shut off and children do not have access. Lead testing repairs will be completed on Appointment for corrections are scheduled for March 2, 2023 by replacing sinks and installing filters to the water sources in order to correct the lead exceedance. Director or Lead Exceedance team will send LPA an email confirming correction by POC date 03/15/2023.

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Based on record review the licensee did not ensure water source at facility meet lead requirements. Lead test results showed that five water sources have an action level exceedance. LPA observed water sources are inaccessible to children.
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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:Valarie Cook
LICENSING EVALUATOR NAME:Dayna Chambers
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023


LIC809 (FAS) - (06/04)
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