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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017158
Report Date: 12/09/2022
Date Signed: 12/09/2022 03:15:19 PM

Document Has Been Signed on 12/09/2022 03:15 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORAFACILITY NUMBER:
198017158
ADMINISTRATOR:RAYMOND HERNANDEZFACILITY TYPE:
850
ADDRESS:2590 INDUSTRY WAYTELEPHONE:
(310) 669-9440
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 40TOTAL ENROLLED CHILDREN: 31CENSUS: 22DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ola Bailey, Site SupervisorTIME COMPLETED:
04:00 PM
NARRATIVE
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On 12/09/2022 at 1:45 PM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced - Case Management inspection and met with Ola Bailey, Site Supervisor. LPA disclosed the purpose of the inspection and was granted entry into the facility by facility staff.

LPA arrived during facility's nap time, and observed there were 22 children napping on mats and five staff present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. The Department received results that there is an action level exceedence (ALE) of lead result of 11. LPA observed two water sources at the facility, one in classroom sink that has a faucet and water fountain by art materials and a faucet in the kitchen. Per Site Supervisor, she is aware that facility has tested for lead but was not made aware of result until notification by The Department.

Site Supervisor provided LPA with LIC 9275 and Facility Sketch with water sources labeled. Per Site Supervisor, she does not have LIC 9276 at this time. LPA provided Site Supervisor with LIC 9276 and PIN 21-21-CCP during today's visit.

At 2:35 PM. LPA observed and took pictures of water sources. Per Site Supervisor, children use filter water dispenser for drinking water which is used to fill water pitchers and children are provided individual cups through out the day. LPA observed filter water dispenser during inspection located across from facility Kitchen along with water pitchers and paper cups. At 2:40 PM, LPA observed Site Supervisor cover water fountain in sink by art area to make this water source inaccessible to children in care. Per Site Supervisor, facility does not prepare food here at facility as food is provided by food program "Chefables" and delivered to facility. LPA observed facility menu from "Chefables" at time of inspection and provided copy of meal time services policy from Parent Handbook.
Report Continues - Page 1 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORA
FACILITY NUMBER: 198017158
VISIT DATE: 12/09/2022
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A deficiency was cited to ensure that the water sources with the exceedance will not be used as a drinking source or food preparation source for the children.

The deficiency listed on the following page was observed by the LPA and is being cited in accordance with
California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Site Supervisor, Ola Bailey.

Report Ends - Page 2 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2022 03:15 PM - It Cannot Be Edited


Created By: Katrina Chicote On 12/09/2022 at 02:46 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: ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORA
FACILITY NUMBER: 198017158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
101700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, 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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Per Site Supervisor, she will provide LIC 9276 and will also provide written declaration on policy and procedures for drinking water and food preparation by POC date. LPA observed Site Supervisor cover drinking fountain making it inaccessible to children at time of inspection.
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Based on observation and record review the licensee did not ensure water sources at facility meet lead requirements. Lead test results showed that a water source has an action level exceedance. SIte Superivsor states children do not use water fountain but LPA observed water source is accessible to children at time of inspection. 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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022


LIC809 (FAS) - (06/04)
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