MONTICELLO CHILD DEVELOPMENT CENTER

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst(LPA) Anna Morales conducted a Case Management- Lead Testing/Exceedance visit and met with Director Celena Jhun. LPA, also, spoke to Trinh Trinh on the telephone to discuss the purpose of the visit. LPA was informed that the first Lead Sample test was conducted on 5/8/23 in 21 areas. Level Exceedance(ALE) were found in two locations: SL-W03 Guppy Room-Right Side Fountain=26.4 and in SL-W15 Kids Castle-Left Side Fountain=11.8. LPA was informed that all of the drinking faucets were removed. Directors stated that the children bring their own water bottles and have access to refills( by filter water). During today's inspection LPA Morales obtained the following documents; Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, fully labeled with locations of all water outlets, and full lead report. During today's inspection, LPA requested verification of passing lead test results for the above outlets' that was retested on 7/25/23. LPA toured the facility and observed that all of the drinking faucets were removed. A Type B deficiency was issued during visit, exit interview conducted, and a copy of this report was reviewed with the Director Celena Jhun. Appeal rights were reviewed and provided. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS. SUPERVISORS NAME: Gladys Kuizon LICENSING EVALUATOR NAME: Anna Morales LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023 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 2 FACILITY NAME: MONTICELLO CHILD DEVELOPMENT CENTER FACILITY NUMBER: 434400282 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/09/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 08/16/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Lead Testing Written Directives 101700.3 (b)(1), a result with values 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was met as evidenced by:1 2 3 4 5 6 7Facility removed all Drinking Faucets from the premises. Children bring their own water bottles and have access to refills from Filter water from the Facility. Director to submit proof of non-ALE results for all outlets by the POC date. 8 9 10 11 12 13 14Lead testing conducted on 5/8/23 showed ALE on 2 outlets in the facility. This posed a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Gladys Kuizon LICENSING EVALUATOR NAME:Anna Morales LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst(LPA) Anna Morales conducted a Case Management- Lead Testing/Exceedance visit and met with Director Celena Jhun. LPA, also, spoke to Trinh Trinh on the telephone to discuss the purpose of the visit. LPA was informed that the first Lead Sample test was conducted on 5/8/23 in 21 areas. Level Exceedance(ALE) were found in two locations: SL-W03 Guppy Room-Right Side Fountain=26.4 and in SL-W15 Kids Castle-Left Side Fountain=11.8. LPA was informed that all of the drinking faucets were removed. Directors stated that the children bring their own water bottles and have access to refills( by filter water). During today's inspection LPA Morales obtained the following documents; Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, fully labeled with locations of all water outlets, and full lead report. During today's inspection, LPA requested verification of passing lead test results for the above outlets' that was retested on 7/25/23. LPA toured the facility and observed that all of the drinking faucets were removed. A Type B deficiency was issued during visit, exit interview conducted, and a copy of this report was reviewed with the Director Celena Jhun. Appeal rights were reviewed and provided. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS. SUPERVISORS NAME: Gladys Kuizon LICENSING EVALUATOR NAME: Anna Morales LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023 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 2 FACILITY NAME: MONTICELLO CHILD DEVELOPMENT CENTER FACILITY NUMBER: 434400282 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/09/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 08/16/2023 Section Cited 101700.3(b)(1) 1 2 3 4 5 6 7Lead Testing Written Directives 101700.3 (b)(1), a result with values 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was met as evidenced by:1 2 3 4 5 6 7Facility removed all Drinking Faucets from the premises. Children bring their own water bottles and have access to refills from Filter water from the Facility. Director to submit proof of non-ALE results for all outlets by the POC date. 8 9 10 11 12 13 14Lead testing conducted on 5/8/23 showed ALE on 2 outlets in the facility. This posed a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Gladys Kuizon LICENSING EVALUATOR NAME:Anna Morales LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023