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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371267
Report Date: 03/07/2023
Date Signed: 03/07/2023 11:36:35 AM

Document Has Been Signed on 03/07/2023 11:36 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:WILSHIRE AVENUE PRESCHOOLFACILITY NUMBER:
304371267
ADMINISTRATOR:MARVEL, JENNIFERFACILITY TYPE:
850
ADDRESS:212 EAST WILSHIRE AVENUETELEPHONE:
(714) 451-0050
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 93TOTAL ENROLLED CHILDREN: 72CENSUS: 51DATE:
03/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Jennifer MarvelTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced Case Management visit. LPA met with Director Jennifer Marvel to discuss the Lead Sampling Testing conducted on 01/20/23. 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 01/20/2023 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. On 03/01/23 Ms. Marvel was advised that the Lead Sample Report was to be posted.

Director Marvel stated the outlet G in the kitchen is used for washing dishes only. The outlet H which is the filtered drinking water came back lower than 1. The Outlet G level was measured with a Action Level Exceedance (ALE) of lead at 8.9ppb and had been made inaccessible with sign posted. Per Director the sink was made inaccessible as soon as results were received 02/24/203 . Director also reported children never used outlet G. Facility uses Church's faucet for cleaning dishes.
LPA verified that the test sample results were posted and verified documentation of the action that the facility had taken.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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: WILSHIRE AVENUE PRESCHOOL
FACILITY NUMBER: 304371267
VISIT DATE: 03/07/2023
NARRATIVE
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(Page 2 of Report)

Based on LPA's observation, interview with Director, Jennifer Marvel, review of facility's sketch and documentation regarding action taken to fix the identified outlets, 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.


Exit interview conducted and report was reviewed with Director Marvel and Licensee Rep Pastor Lucero.

A notice of site visit was given and must remain posted for 30 days. The Notice of Site Visit was given and discussed it must be posted as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to do so will result in a civil penalties of $100.00

Appeal Rights and deficiency were explained. Ms. Jennifer Marvel 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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2023 11:36 AM - It Cannot Be Edited


Created By: Pat Rivas On 03/07/2023 at 10:32 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WILSHIRE AVENUE PRESCHOOL
FACILITY NUMBER: 304371267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/07/2023
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
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Director had outlets repaired and or replaced and reflushed. Director will have outlet retested and provide LPA with new report
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was not met evidenced by:Lab report water analysis from Outlet G (8.9 ppb) taken on 01/20/2023 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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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