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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003297
Report Date: 04/12/2024
Date Signed: 04/12/2024 09:35:19 AM

Document Has Been Signed on 04/12/2024 09:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:OPTIONS SURROUND CARE-ROOSEVELTFACILITY NUMBER:
198003297
ADMINISTRATOR/
DIRECTOR:		DIANA FREEMANFACILITY TYPE:
840
ADDRESS:5356 DELTA AVENUETELEPHONE:
(626) 285-2195
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY: 40TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
04/12/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Elizabeth Andrade, Site DirectorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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On 04/12/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced Case Management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. A COVID 19 risk assessment was conducted prior to entering the facility. LPA met with Elizabeth Adrade, Site Director and explained the purpose of the visit. Present in the facility is 1 Staff and 0 Children.

Analyst 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 SIte Director during the inspection. Per AB 2370, all CCCs that are 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 sketch and required forms LIC 9275, LIC9276 and LIC999 was received by the Department on 04/03/2024.

The State Water Resources Control Board (SWRCB) report indicated the facility was inspected and samples were collected on 08/24/2023. Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

· Drinking Fountain- A (14 UG/L) – LPA observed drinking fountain was removed and capped - picture was taken.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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: OPTIONS SURROUND CARE-ROOSEVELT
FACILITY NUMBER: 198003297
VISIT DATE: 04/12/2024
NARRATIVE
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Staff stated that the Drinking Fountain A has not been in use. Facility uses tap water from the bathroom and place in a water jug.

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.

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 this report and appeal rights provided to Elizabeth Adrade, Site Director.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/12/2024 09:35 AM - It Cannot Be Edited


Created By: Kruz Long On 04/12/2024 at 09:16 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: OPTIONS SURROUND CARE-ROOSEVELT
FACILITY NUMBER: 198003297

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers. (b) Testing results with fractional readings of parts per billion (ppb) 0.5 ppb or greater shall be rounded before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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During the inspection, LPA observed the drinking fountain was removed and capped. Deficiency was cleared during this visit.
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This requirement is not met as evidenced by Based on inspection, the licensee did not comply with the directive above, as the Drinking Fountain A tested with an Action Level Exceedance (ALE) of 14 UG/L. 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:Ana Chico
LICENSING EVALUATOR NAME:Kruz Long
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


LIC809 (FAS) - (06/04)
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