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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871630
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:07:54 PM

Document Has Been Signed on 03/21/2023 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LA MIRADA HEAD STARTFACILITY NUMBER:
191871630
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5637 LA MIRADA AVE.TELEPHONE:
(323) 464-6982
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 75TOTAL ENROLLED CHILDREN: 48CENSUS: 21DATE:
03/21/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Teacher, Maria CalderonTIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPAs) Mireya Garcia and Seung Lee conducted an unannounced case management inspection. Upon arrival LPAs met with Teacher Maria Calderon. Child Development Supervisor, Samira Alvarez later arrived during this inspection. Census was taken.

During the inspection LPAs 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 representative 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 LPAs.

Facility provided a copy of the facility sketch, LIC 9276, and LIC 9275 to LPA Garcia prior to the inspection.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
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 2
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LA MIRADA HEAD START
FACILITY NUMBER: 191871630
VISIT DATE: 03/21/2023
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On 12/16/2022, 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 10/13/2022. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

· A sink located inside the classroom #4 of the facility (9.0 UG/L) – Per facility representative this sink has not been used since June of 2022, due to low enrollment. The location of the sink was verified in person during this inspection.

Since the sink was never used for consumption or food preparation even when children did use the sink, no deficiencies were cited during this inspection.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with facility representative Samira Alvarez. Appeal rights discussed and explained.

REPORT ENDS HERE PAGE 2 OF 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC809 (FAS) - (06/04)
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