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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020552
Report Date: 03/19/2026
Date Signed: 03/19/2026 03:13:17 PM

Document Has Been Signed on 03/19/2026 03:13 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:AZUSA UNIFIED SCHOOL DISTRICT/CHARLES LEEFACILITY NUMBER:
198020552
ADMINISTRATOR/
DIRECTOR:		JENNY LEFACILITY TYPE:
850
ADDRESS:550 N CERRITOS AVETELEPHONE:
(626) 815-4724
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 40TOTAL ENROLLED CHILDREN: 13CENSUS: 13DATE:
03/19/2026
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Program Manager, Tiffany CarreyTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 03/19/26 at 11:35am, Licensing Program Analyst (LPA) Diana Ortiz conducted an unannounced case
management inspection for an Action Level Exceedance (ALE) detected in a water fixture in the facility. LPA met with Program Manager, Tiffany Carey, whom the reason for the visit was explained. LPA was led on a tour of the facility. A census of the facility was taken. There were 13 daycare children, and two (2) teachers/staff present. This preschool has an afternoon program that operates from 12:10pm-3:10pm. Facility was within ratio & capacity.

Analyst 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.

On 03/09/26, the Department received notification from the State Water Resources Control Board (SWRCB), Division of Drinking Water (DDW). The SWRCB report indicated the facility was inspected and samples were collected on 02/25/26. Facility provided facility sketch and required forms LIC 9276, LIC999 and LIC9275 to LPA on 03/19/26.
Faucets and drinking fountain reported with 5.5 ppb or greater lead exceedance levels were as follows:

Sample Site B– PRE-K, CLASSROOM, NORTHWEST. FAUCET (5.89 UG/L) – Faucet currently not in use.

Per Program Manager, the water outlet labeled B is used for handwashing and is located on the north wall, west of the restrooms.
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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AZUSA UNIFIED SCHOOL DISTRICT/CHARLES LEE
FACILITY NUMBER: 198020552
VISIT DATE: 03/19/2026
NARRATIVE
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 A plastic covering has been securely placed over the entire sink and faucet (outlet labeled B), physically preventing use and making it inaccessible to children and staff. Additionally, a sign is posted over the paper towel dispenser directing individuals to use an alternate faucet, reinforcing that this sink should not be used. A portable handwashing station has been set up inside the classroom (near the restrooms) to support hygiene practices while the primary faucet is undergoing lead testing. Handwashing procedure posters are displayed at eye level to guide proper technique.

Per Program Manager, it was determined that the previously reported lead testing exceedance results for this facility had been submitted under a different facility number (AUSD/Henry Dalton #198020493). The initial laboratory report incorrectly identified the licensed facility number, resulting in the exceedance being associated with another site in SWRCB. Upon verification, LPA confirmed via documentation provided by Director Jenny Le and Program Manager Tiffany Carey, that the lead testing exceedance pertains to this facility location (AUSD/Charles Lee #198020552). Per Program Manager, the facility has contacted the laboratory to correct the report, and updated documentation reflecting the correct facility number has been requested and will submit to LPA for review. LPA advised the facility to review all identifying information on future environmental testing submissions to ensure accuracy and regulatory compliance.

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

Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D(deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted or 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, a copy of the report, PIN 21-21-CCP and appeal rights were provided to Program Manager, Tiffany Carey.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/19/2026 03:13 PM - It Cannot Be Edited


Created By: Diana Ortiz On 03/19/2026 at 12:54 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: AZUSA UNIFIED SCHOOL DISTRICT/CHARLES LEE
FACILITY NUMBER: 198020552

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2026
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..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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A plastic covering has been securely placed over the entire sink and per Program Manager the facility will remediate outlet labeled B and retested before use. Program manager will provide status and provide updated documents to LPA by POC due date of 04/20/26.
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Based on observation the licensee did not comply with the directive above, as one (1) out of three (3) faucets tested with an Action Level Exceedance (ALE).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.
Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:
Diana Ortiz
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2026


LIC809 (FAS) - (06/04)
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