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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013130
Report Date: 03/22/2024
Date Signed: 03/22/2024 11:08:00 AM

Document Has Been Signed on 03/22/2024 11:08 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CROSSROAD MONTESSORI CHILD CARE CENTERFACILITY NUMBER:
198013130
ADMINISTRATOR:PANFILIA GONZALEZFACILITY TYPE:
850
ADDRESS:12900 CROSSROAD PARKWAY SOUTHTELEPHONE:
(562) 908-4413
CITY:CITY OF INDUSTRYSTATE: CAZIP CODE:
91746
CAPACITY: 57TOTAL ENROLLED CHILDREN: 29CENSUS: 9DATE:
03/22/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Panfilia GonzalezTIME COMPLETED:
11:20 AM
NARRATIVE
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On 3/22/2024, at 9:00 am Licensing Program Analysts (LPAs) Carolyn Tuba and Priscilla Ochoa conducted an unannounced Case Management Lead Exceedance inspection. A COVID 19 risk assessment was conducted. LPAs met with Director, Panfilia Gonzalez. Director guided LPAs, who observed 9 children and 2 staff present at the facility during this inspection.

The purpose of today's inspection is to go over the water lead test results received on 3/22/2024. Results indicate that fixture “A” water fountain source in Preschool classroom (Mustang Room) had a lead exceedance of 6.13 which exceed the regulation of less than 5.5 parts per billion. During the visit, LPAs took photo of water fountain which was bagged with a sign stating, “Out of Service”. LPAs received documentation including photos, LIC 9275, LIC 9276, lead results and facility sketch.

On 11/30/2022 licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for Water Fountain fixture “A” water outlet. Water testing results identified with Action Level Exceedance as identified outlet. Water testing results identified with Action Level Exceedance as defined in Written Directives section 101700.3 are not deemed safe to drink.

According to Director children are given bottled water from Sparklett’s and children bring a water cup from home labeled with their name. LPAs advised Director that lead testing results must be posted outside for parents to view until the next testing is conducted every 5 years from the date of the initial test. Director stated that parents were told about the results but will post on the parent board. Per Director she is waiting to have the water fountain fixed and retested or it may be removed.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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 03/22/2024 11:08 AM - It Cannot Be Edited


Created By: Carolyn Tuba On 03/22/2024 at 09:17 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: CROSSROAD MONTESSORI CHILD CARE CENTER
FACILITY NUMBER: 198013130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2024
Section Cited
CCR
101700.3

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101700.3 California Lead Action Level at Child Care Centers. "Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of the Written Directives, for the health and safety of children in care"

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Per Director she is waiting for the county to have the water fountain fixed and retested or it may be removed.
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This requirement is not met as evidenced by: Testing results provided by the facility with an Action Level Exceedance (ALE) of 6.13 on the water fountain "A" outlet, which poses/posed a potential health, safety or personal rights risk to persons 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:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CROSSROAD MONTESSORI CHILD CARE CENTER
FACILITY NUMBER: 198013130
VISIT DATE: 03/22/2024
NARRATIVE
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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.

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.


A deficiency was cited on attached 809D. The deficiency listed on the following page were reviewed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with the Director, Panfilia Gonzalez.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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