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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016557
Report Date: 08/02/2023
Date Signed: 08/02/2023 10:37:27 AM

Document Has Been Signed on 08/02/2023 10:37 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BURROUGHS HEAD STARTFACILITY NUMBER:
198016557
ADMINISTRATOR:SOPHIA JOHNSON & IRENE DAYFACILITY TYPE:
850
ADDRESS:1260 E. 33RD STREETTELEPHONE:
(562) 427-3424
CITY:SIGNAL HILLSTATE: CAZIP CODE:
90755
CAPACITY: 60TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
08/02/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Facility RepresentativesTIME COMPLETED:
10:50 AM
NARRATIVE
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On 08/02/2023 at 9:50 AM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management Inspection and met with Olivia Ugarte (ELCM), Maria Harris (Program Administrator), and Keokuk Legarde (ELCM). LPA disclosed the purpose of the inspection and was granted entry into the facility. Facility is made up of three classrooms RM-1 Preschool, RM-2 Early Head Start, and RM-3 Early Head Start and located on Burroughs Elementary school campus.

There was one child and three staff present during the inspection in RM-2. Per ELCM, RM-1 is Preschool program and is still on Summer break. LPA did not observe any children in RM-1 and RM-3 at time of inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that the classroom drinking fountains (bubblers) in RM-1 and RM-2 has action level exceedance (ALE) of lead: RM-1 drinking fountain results 7.0 and RM-2 drinking fountain results 8.84.

At 9:58 AM. LPA observed and took pictures of the water sources with ALE. LPA observed drinking fountain in RM-2 to be inaccessible to children covered completely with plastic cover. LPA did not observe a cover on RM-2 drinking fountain but when tested drinking fountain was observed to be off and no children are present in RM-1. LPA observed water jugs available for children drinking water. Per ELCM, parents will be notified pending a letter distributed by LBUSD. Per ELCM, no meals are prepared on site and all meals are delivered by Head Start Kitchen.

A deficiency was cited to ensure that the water sources with the exceedances will not be used as a drinking source or food preparation source for the children.

A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted and report was reviewed with Facility Representatives.
Report Ends - Page 1 of 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 08/02/2023 10:37 AM - It Cannot Be Edited


Created By: Katrina Chicote On 08/02/2023 at 10:25 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BURROUGHS HEAD START
FACILITY NUMBER: 198016557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
Section Cited
HSC
101700.3(b)(1)

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101700.3(b)(1)
(b) Testing results with fractional ppb 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... Action Level Exceedance. This requirement was not met as evidence by:
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LPA observed all water sources to be made inaccessible to children one turned off and the other covered. LPA observed water jugs available next to drinking fountains for drinking water. Clearing deficiency on site.
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Based on record review the Licensee did not ensure water sources at facility to meet lead requirements. Lead test results showed that two water sources have an action level exceedance. This poses a potential health, safety, and personal rights 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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
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