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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013437
Report Date: 01/09/2024
Date Signed: 01/09/2024 01:31:24 PM

Document Has Been Signed on 01/09/2024 01:31 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:FIREHOUSE PRESCHOOLFACILITY NUMBER:
198013437
ADMINISTRATOR:CATHERINE MARCELLINEFACILITY TYPE:
850
ADDRESS:1923 N. ALLEN AVENUETELEPHONE:
(626) 798-2865
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 51TOTAL ENROLLED CHILDREN: 37CENSUS: 34DATE:
01/09/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sonam Gehi and Catherine MarcellinTIME COMPLETED:
01:30 PM
NARRATIVE
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On January 9, 2024, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced Case Management Lead Exceedance inspection. A COVID risk assessment was conducted. LPA met with staff in charge, Sonam Gehi due to Director, Catherine Marcelline was not available but was on her way to the facility. LPA took a tour and gained a census of 34 children with 4 staff in care. During the visit Director arrived at approximately, 10:15 am.

The purpose of today's inspection is due to results of a lead exceedance on fixture “B” sink faucet water source in the 2-year-old classroom next to the changing table had a lead exceedance of 15 parts per billion which exceed the regulation of 5.5 or less parts per billion. LPA did observe that it is labeled with a letter “E” that was placed by the Lead inspector. LPA received documents from the Program Director that was provided by the Lead inspector, but Director did not have the facility sketch, LIC 9275 and LIC 9276 or lead results. Program Director is attempting to get a hold of the Lead inspector and will provide documentation to LPA via email by 1/19/2024. LPA took photos of lead exceedance that water fixture was bagged with sign that stated not to use. Per Director they will be fixing sink and conducting retesting on January 20, 2024. LPA provided consultation and 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. LPA provided PIN 21-21.1-CCP.

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.

An exit interview was conducted with Director, Catherine Marcelline and a copy of this report and Notice of Site Visit was provided and shall be posted for 30 days in an area accessible for review.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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 01/09/2024 01:31 PM - It Cannot Be Edited


Created By: Carolyn Tuba On 01/09/2024 at 12:30 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FIREHOUSE PRESCHOOL
FACILITY NUMBER: 198013437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
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... (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Per Director sink next to changing table will be fixed and retested. Director will provide documention with new results to LPA via email.
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This requirement is not met as evidenced by: Based on testing results with an Action Level Exceedance (ALE) 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: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
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