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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814893
Report Date: 04/07/2023
Date Signed: 04/07/2023 12:35:41 PM

Document Has Been Signed on 04/07/2023 12:35 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABC CHILD CARE VILLAGEFACILITY NUMBER:
334814893
ADMINISTRATOR:ANGELINE ANTON (ANGEL)FACILITY TYPE:
850
ADDRESS:40045 VILLAGE ROADTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 216TOTAL ENROLLED CHILDREN: 216CENSUS: 54DATE:
04/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Angel Anton & Candace LawrenceTIME COMPLETED:
01:15 PM
NARRATIVE
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On April 7, 2023, at 12:31 PM, Licensing Program Analyst’s (LPA’s) Anastasia Flores and William Chancellor, made an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Director, Angel Anton and Assistant Director Candace Lawrence and proceeded to tour the facility with Candance Lawrence. Also present in the facility were 40 daycare children and 13 teachers/staff. Facility was within ratio & capacity. On 04/07/23, LPA Anastasia Flores interviewed the director, and examined the faucets and drinking fountains deemed an Action Level Exceedance. Facility provided facility sketch and plan of correction via email on 03/16/23. The required signed and dated forms (LIC 9275/9276) were submitted to Community Care Licensing via email on 03/16/23.

Label A: Faucets and drinking fountains reported with 7.700 ppb or greater lead exceedance levels were as follows:

1 drinking fountain identified as having high levels of lead. The drinking fountain was located outside the on the playground and has been labeled with red & white sign not to use until approved. On 04/07/23, LPA Flores, was informed that the fountain has not been used by anyone and is scheduled to be re-flushed in one week before the facility can have it tested again. The facility provides filtered water for the children in care.

Based on records review and information received, and current policies and procedures for the Department, the facility is being cited for having a lead exceedance in water fountain labeled letter Y, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers. This poses a potential health, safety, or personal rights risk to the children in care.

An exit interview was conducted, a copy of this report, 809D and appeal rights were handed to facility Director, Angel Anton. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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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Document Has Been Signed on 04/07/2023 12:35 PM - It Cannot Be Edited


Created By: Anastasia Flores On 04/07/2023 at 11:54 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ABC CHILD CARE VILLAGE
FACILITY NUMBER: 334814893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3 (b) (1) California Lead Action Level at Child Care Centers 101700.3 (b) (1) Written Directives...A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidence by:
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Facility has marked the faucet off limits for the staff, it is unreachable for children to use and it is currently being flushed weekly prior to facility having the sink retested. Note the fountains are not used for drinking water or food preparation and water has been turned off to that fountain.
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Based on records review and interviews, facility tested over the Action Level Exceedance, in one drinking fountain located outside next to the picnic tables. This poses a potential health, safety, or personal rights risk to the 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023


LIC809 (FAS) - (06/04)
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