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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412826
Report Date: 04/18/2024
Date Signed: 04/18/2024 01:49:59 PM

Document Has Been Signed on 04/18/2024 01:49 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:STONEHURST ELEMENTARY SCHOOL STATE P.S.FACILITY NUMBER:
197412826
ADMINISTRATOR/
DIRECTOR:		IMPERIALE, JILLFACILITY TYPE:
850
ADDRESS:9851 STONEHURST AVENUE RM. 2TELEPHONE:
(818) 767-8014
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 24TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
04/18/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Ruth Kim, PrincipalTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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At 9:40 am Licensing Program Analysts (LPAs) Roxana Lopez and Saul Valenzuela conducted an unannounced case management inspection for an Action Level Exceedance (ALE) detected in water fixtures in the facility. A COVID 19 risk assessment was conducted prior to entering the facility. LPAs met with Principal, Ruth Kim, during the visit. Census was taken.

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 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 did provide facility sketch and required forms LIC 9276, LIC 999 and LIC 9275 to the department. Required forms were provided to LPAs via email on this date. On 3/07/2024, 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 10/20/2022. -Faucets reported with 5.5 ppb or greater lead exceedance levels were as follows:----------------------------------------------------pg.1 of 2 --------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: STONEHURST ELEMENTARY SCHOOL STATE P.S.
FACILITY NUMBER: 197412826
VISIT DATE: 04/18/2024
NARRATIVE
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  • Room # 2 Classroom sink fixture (A) (38.400 UG/L)
  • Room # 2 Play yard sink fixture (B) (9.660 UG/L)
  • Room # 2 Play yard drink fixture (B30) (8.550 UG/L)

Point- of use- filters were installed on faucets mentioned above- all faucets were re-tested on 12/09/2022. The Department received notification from the State Water Resources Control Board(SWRCB), Division of Drinking Water (DDW) on 3/8/2024 that faucet mentioned above have passed the lead testing- no lead exceedance present.

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

See LIC809D for Type B deficiency cited. Deficiency cited today was cleared and planned of correction (POC) letter was given.

A notice of site visit was also provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Principal Ruth Kim. ----------------------------- pg 2 of 2 ----------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/18/2024 01:49 PM - It Cannot Be Edited


Created By: Saul Valenzuela On 04/18/2024 at 10:53 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: STONEHURST ELEMENTARY SCHOOL STATE P.S.
FACILITY NUMBER: 197412826

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2024
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1)California Lead Action Level at Child Care Centers. (b) Testing results with...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 deemed an Action Level Exceedance. This requirement is not me at evidenced by
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Point- of- use filters were installed on each facuets. Faucets were re-tested on 12/09/2022, passing with no Lead exccedence. The department received results on 3/08/2024.
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Based on ispection, the licensee did not comply with the directive above, as that Sink faucet A, B, and B30 tested with an Action Level Exceedance (ALE) of 38.400, 9.660, and 8.550 ppb. This poses a potential health and safety 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024


LIC809 (FAS) - (06/04)
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