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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418919
Report Date: 05/07/2024
Date Signed: 05/07/2024 02:17:54 PM

Document Has Been Signed on 05/07/2024 02:17 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:HEAVENLY VISION EDUCATION CENTER INC.FACILITY NUMBER:
197418919
ADMINISTRATOR/
DIRECTOR:		SCRANTON-LEE, SANDYFACILITY TYPE:
850
ADDRESS:600-604 W ALONDRA BLVDTELEPHONE:
(424) 296-5253
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 8DATE:
05/07/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Director Shelley WilliamsTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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On May 7, 2024, at 12:30 PM, Licensing Program Analysts (LPAs) A. Wallin and A. Mooberry conducted an unannounced case management inspection and was met with director, Shelley Williams, who provided assistance. LPA toured the facility and a census was taken. LPA observed today's census was one staff and eight children.

The purpose of today's inspection was to go over the water lead test results discovered on 4/222024. Results show the outdoor three-station water fountain containing sample sites C, D, E have an action level exceedance of lead. The first water fountain station, sample site C, had a lead result of 140.0 ppb. The second fountain station, sample site D, had a lead result of 140.0 ppb. The third fountain station, sample site E, had a lead result of 64.0 ppb. Per director, facility fix for the three-station water fountain was to shut it off. Photo evidence provided of water line valve being turned off.

During inspection, LPAs observed facility three-station water fountain valve turned in the off position. LPA discussed with director regarding permanent solutions for lead exceedance. Per director, she will conduct research to make a permanent solution. Per director, facility provides drinking water via store bought water bottles along with a water fountain source located in the classroom, sample site A with lead result of 1.5 ppb. Per director three-station water fountain containing sample sites C, D, E is not being used for drinking consumption purposes. During facility visit, LPAs provided a copy and reviewed PIN 21-21.1 CCP with director. LPAs discussed with director regarding plans of correction, remediation and lead action exceedance response requirements according to PIN 21-21.1 CCP. A deficiency was cited to ensure that the water fountain noted will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page were observed by LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. During facility visit, LPAs collected the written plan of correction (POC) to permanently disabled the water fountain. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Shelley Williams.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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Document Has Been Signed on 05/07/2024 02:17 PM - It Cannot Be Edited


Created By: Angelica Wallin On 05/07/2024 at 01:09 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: HEAVENLY VISION EDUCATION CENTER INC.
FACILITY NUMBER: 197418919

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2024
Section Cited
CCR
101700.3(b)(1)-(b)

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Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidence by record review. Lead test results showed that three water sources had an action level exceedance.
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During facility visit, LPAs collected the plan of correction (POC) to permanently disabled the three-station water fountain source. Director to submit pictures of permanently disable water sources with lead exceedance via emai
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LPAs observed facility three-station water fountain valve turned in the off position. This is a potential risk to the health and safety of the
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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:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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