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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614019
Report Date: 04/12/2023
Date Signed: 04/12/2023 03:20:04 PM

Document Has Been Signed on 04/12/2023 03:20 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.FACILITY NUMBER:
300614019
ADMINISTRATOR:CARRILLO, AUDRIANNAFACILITY TYPE:
850
ADDRESS:13431 EDWARDS STREETTELEPHONE:
(714) 894-0144
CITY:WESTMINISTERSTATE: CAZIP CODE:
92683
CAPACITY: 102TOTAL ENROLLED CHILDREN: 102CENSUS: 46DATE:
04/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Director, Audriana CarrilloTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Nguyen conducted an unannounced Case Management visit. LPA Nguyen met with Director, Audriana Carrillo. At 2:35pm, census was taken and there were 8 staff members and 46 preschool age children. LPA discussed the Lead Sampling Testing conducted on 03/04/23. Director was advised on 04/10/2023 that the Lead Sample Report was to be posted. Director provided LPA’s copies of all documentation requested regarding Lead; LIC 999 Facility Sketch, LIC 9275 and LIC 9276. LPA confirmed that facility had posted the Lead Sample Report during visit on 4/12/2023.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test. Community Care Licensing was notified that lead water testing conducted at the facility on 03/04/2023 failed allowable limit for lead. The purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE).

Instructions for required lead testing are outlined in PIN 21-21-CCP. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

Child Care Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in parts per billion (ppb) unit of measurement.

LPA’s observed outlet F is a sink faucet located in room 5. Director covered the outlet with plastic and posted a “Do Not Use” sign on the outlet. Children bring their own water bottle to the school and facility provides water for children in filtered pitchers and cups.

Based on LPA's observation, record reviews and interview with the Director, Audriana Carrillo the following violation was observed and is being cited in accordance with Written Directives Section 101700.3 (b)(1) California Lead Action Level at Child Care Centers, is being cited on the attached LIC 809D. Continued on Page 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.
FACILITY NUMBER: 300614019
VISIT DATE: 04/12/2023
NARRATIVE
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Exit interview conducted and report was reviewed with Director, Audriana Carrillo. A notice of site visit was given and must remain posted for 30 days. Appeal Rights and deficiency were explained. The Director was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/12/2023 03:20 PM - It Cannot Be Edited


Created By: Cindy Nguyen On 04/12/2023 at 02:56 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.
FACILITY NUMBER: 300614019

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2023
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded ...(1) A result with values of 5.5 ppb or greater shall be deemed an Action... This requirement was not met as evidenced by:
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Director posted the lead sampling test results. The outlet was closed off with sign "Do not use". The Director stated they will retest the outlet and provide copies of the new test results to LPA by 5/10/23.
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Lab report analysis water from Outlet F (6.0 ppb) taken on 03/04/2023 indicated levels of lead in exceedance. This poses a potential risk to the health, safety and personal rights of 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:Patricia Magana
LICENSING EVALUATOR NAME:Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


LIC809 (FAS) - (06/04)
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