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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270647
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:33:05 PM

Document Has Been Signed on 10/26/2022 03:33 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:FAMILY CAMPUS PRESCHOOLFACILITY NUMBER:
304270647
ADMINISTRATOR:VICTORIA HERNANDEZFACILITY TYPE:
850
ADDRESS:10540 CHAPMAN AVENUETELEPHONE:
(714) 741-0970
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 112TOTAL ENROLLED CHILDREN: 67CENSUS: 47DATE:
10/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Victoria Hernandez, DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Rivas made an unannounced Case Management visit. LPA met with Director, Victoiria Hernandez, to discuss the Lead Sampling Testing conducted on 09/10/22.

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 09/10/2022 failed allowable limit for lead. The Purpose of today’s visit is to follow up with the 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.

Director was advised on 09/29/22 that the Lead Sample Report was to be posted. Director stated the outlet F (in frog classroom)with a high levels of lead at 6.0ppb, was made inaccessible on 09/29/22. LPA verified that the the Director has posted the test result and the outlets F was made inoperable by the facility. Director stated that they did not use the water for drinking or cooking only to wash hands. The children in the facility bring and have water bottles. Facility also has extra water bottles to provide to the children as needed.



Based on LPA's observation, interview with Director, review of facility's sketch, 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. (Continue next page)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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 3
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: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647
VISIT DATE: 10/26/2022
NARRATIVE
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(Page 2 of Report)

Exit interview conducted and report was reviewed with Director Victoria Hernandez. 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 01/16) 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.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/26/2022 03:33 PM - It Cannot Be Edited


Created By: Pat Rivas On 10/26/2022 at 03:15 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: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/28/2022
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results...comparing to the Action Level. (1) A result with values of 5.5 part per billion or greater shall be deemed an Action Level Exceedance.
This requirement was not met evidenced by:
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Director reports she has made outlet inaccessible, has obtained a portable sink, has contacted a plumber to replace faucet. Director will provide proof (copy of work order and picture) that faucet was replaced and send it to LPA by plan of correction date.
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lab report analysis water from Outlet F(6.0 ppb) taken on 09/10/2022 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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022


LIC809 (FAS) - (06/04)
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