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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400579
Report Date: 01/11/2023
Date Signed: 01/11/2023 11:01:42 AM

Document Has Been Signed on 01/11/2023 11:01 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:ST. ANNE'S EARLY LEARNING CENTER AT LUGOFACILITY NUMBER:
198400579
ADMINISTRATOR:ANNA LOPEZFACILITY TYPE:
830
ADDRESS:4347 PENDLETON AVETELEPHONE:
(213) 381-2931
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 80TOTAL ENROLLED CHILDREN: 28CENSUS: 23DATE:
01/11/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Martha Lopez, Center Manger TIME COMPLETED:
11:30 AM
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On 01/11/2023 at 9:35 AM, Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection and met with Martha Lopez, Center Manager. LPA disclosed the purpose of the inspection and was granted entry into the facility. Facility is located on the rear property of the Lugo Elementary School campus with it's own separate entrance.

There were 23 children and nine teachers present during the inspection.

The purpose of today's inspection was to discuss the water lead test results. Results show that one water source has action level exceedance (ALE) of lead. The drinking fountain located in RM 4B has lead exceedence over 5.5ppb.

At 9:42 AM, LPA observed and took pictures of the water source with ALE. Per Center Manger, RM 4B is currently not being used by children in care due to low enrollment at the facility. LPA observed no children or staff in room during inspection and no sign that room is currently being used by children such as children's belongings, children's work on bulletin boards, or sign in/out sheets in the classroom. Per Center Manager, out of ten classrooms at the facility only five rooms are being used at this time (RMs: 1, 2, 3, 5, and 10). Center Manager states that each classroom has own individual water source that they use and RM 4B is locked through the day, LPA observed Center Manager open RM 4B with a key during inspection.

LPA interviewed A1, Facility Maintenance, stated that facility is currently conducting a flushing process of drinking fountain in RM 4B and provided LPA a copy of tracking sheet per Title 22 Requirements. A1 states they will continue to conduct flushing and once flushing process completed another water sample will be collected.

Report Continues - Page 1 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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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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: ST. ANNE'S EARLY LEARNING CENTER AT LUGO
FACILITY NUMBER: 198400579
VISIT DATE: 01/11/2023
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A deficiency was cited to ensure that the water source with the exceedance will not be used as a drinking source or food preparation source for the children. A deficiency will also be cited to ensure non-contaminated water is made readily available both indoors and outdoors.

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.

Appeal Granted:
An appeal was submitted for the deficiency issued on 01/11/2023 in regards to an ALE, per Appeal submitted the incorrect information was provided to Regional Office by Water Sampler. Correct information was provided to Regional Office and upon review, RM Sharon Greene dismisssed the issued citation. There is no violation on this visit.

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 Facility Representative, Sandra Amaral.

Report Ends - Page 2 of 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
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Document is an Amendment of Original Document on 04/17/2023 11:46 AM


Created By: Katrina Chicote On 01/11/2023 at 10:42 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER AT LUGO
FACILITY NUMBER: 198400579

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/11/2023
Section Cited
CCR
101700.3(b)(1)

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Appeal Granted. No deficiency issued.
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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: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023


LIC809 (FAS) - (06/04)
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