<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019106
Report Date: 02/24/2023
Date Signed: 02/24/2023 10:19:54 AM

Document Has Been Signed on 02/24/2023 10:19 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GOLDEN CITY CHILD DEVELOPMENT CENTER INC.FACILITY NUMBER:
198019106
ADMINISTRATOR:ANGELICA HERRERAFACILITY TYPE:
850
ADDRESS:812 E. CARSON ST.TELEPHONE:
(310) 630-0863
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 72TOTAL ENROLLED CHILDREN: 19CENSUS: 13DATE:
02/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Angelica HerreraTIME COMPLETED:
10:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced case management inspection on 02/24/2023. LPA Navarro arrived at the facility at 08:25 am and met with Director Angelica Herrera who guided LPA on a tour of the facility. There were 13 children and four staff present during the inspection.

The purpose of today's inspection was to go over the water lead test results received on 01/23/2023. Results show that two water sources had action level exceedence of lead. The drinking fountain located in the infant play yard had a lead exceedence of 7.8. LPA Navarro observed the water fountain was covered with a bag and tape to make it inaccessible to children. LPA also observed that the water fountain was shut off. Per Director, the drinking fountain is not used by the infants because they are too small. Currently there are no infants in care.

The other exceedence comes from a faucet located inside classroom three. The faucet had a leas exceedence of 5.5. The sink inside classroom three is not used for food preparation. Currently, classroom three is not being used due to low enrollment. LPA Navarro observed the faucet was covered with a bag and tape to make it inaccessible to children.

Drinking water is provided from water bottles labeled with the children's name. Per Director, food preparation is done in the kitchen where there was no exceedence. A deficiency was cited to ensure that the water faucets noted 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.

Exit interview conducted and report was reviewed with Director Angelica Herrera. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/24/2023 10:19 AM - It Cannot Be Edited


Created By: Raul Navarro On 02/24/2023 at 09:54 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: GOLDEN CITY CHILD DEVELOPMENT CENTER INC.
FACILITY NUMBER: 198019106

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2023
Section Cited
CCR
101700.3(b)(1)

1
2
3
4
5
6
7
(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 Exceedence.
1
2
3
4
5
6
7
Per Director, the drinking fountain will be capped and the water faucet inside classroom three will be flushed and re tested. Director will submit pictures of the capped water fountain and the results of the tested water faucet inside classroom three.
8
9
10
11
12
13
14
This requirement was not met as evidence by record review. Lead test results showed that two water sources had an action level exceedence of 7.8 and 5.5. This is a potential risk to the health and safety of the children in care. During the inspection, LPA observed both water sources were covered with a bag
8
9
10
11
12
13
14
making them inaccessible. The drinking fountain was also shut off.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Raul Navarro
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2