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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200549
Report Date: 10/13/2022
Date Signed: 10/13/2022 12:38:12 PM


Document Has Been Signed on 10/13/2022 12:38 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:VALLEY SCHOOL OF INDIVIDUAL TRAININGFACILITY NUMBER:
191200549
ADMINISTRATOR:MENESES, HEIDYFACILITY TYPE:
850
ADDRESS:15700 SHERMAN WAYTELEPHONE:
(818) 786-4720
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:101CENSUS: 42DATE:
10/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:MENESES, HEIDYTIME COMPLETED:
12:47 PM
NARRATIVE
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On 10/13/2022 at 9:47am, Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management visit at Valley School of Individual Training for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Heidy Meneses (Director) and toured the facility. During today’s visit there are 42 children and 4 teachers.

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 of the results of the Lead Water Testing conducted at the facility on 09/09/2022. The sample test for water/faucet outlet A and H exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

LPA received an email from the facility with copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276); Facility Sketch (LIC 999) in which all water outlets are noted; and A copy of water testing results summary.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VALLEY SCHOOL OF INDIVIDUAL TRAINING
FACILITY NUMBER: 191200549
VISIT DATE: 10/13/2022
NARRATIVE
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During today’s visit LPA observed water fountains A and H identified on facility sketch with elevated lead levels are, labeled out of service, inoperable and facility has ceased usage. LPA took pictures of faucet/outlet A and H.

The director has posted testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility during operating hours.

Based on observation, interviews and sampling records it has been determined that there was a violation. During today’s visit LPA Thompson issued one Type B violation under 101700.3(b)(1) California Lead Action Level at Child Care Centers


see (LIC 809D)

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 up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

LPA discussed the following Plan of Correction with the director. The facility will remove faucet/outlet H and replace it with a new unit pending delivery. This unit is being replaced by a certified plumber from the list provided by the California Rural Water Association. The water faucet/outlet labeled A will be shut off and replaced with alternate water outlet/faucet M pending retesting. At the present time water outlet/faucet M is currently not in use, covered with plastic and labeled out of service.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VALLEY SCHOOL OF INDIVIDUAL TRAINING
FACILITY NUMBER: 191200549
VISIT DATE: 10/13/2022
NARRATIVE
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The facility has provided their intentions of bringing their facility into substantial compliance. The facility will provide notification to parents/guardians of children in care with information about what has been done and remediation plans for all water outlets by 10/14/2022.

LPA provided director with a copy of PIN 21-21-CCP and Lead Testing in CCC Frequently asked Questions

A copy of this facility evaluation report (LIC 809 & LIC 809D), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to the director.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/13/2022 12:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: VALLEY SCHOOL OF INDIVIDUAL TRAINING
FACILITY NUMBER: 191200549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2022
Section Cited

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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... nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance this was not met as evidence by
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Based on lab results water faucet/outlets A and H tested at Action Level Exceedence wichi can poses a potential Health and Safety risk to children under care.
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Association, The water/faucet outlet labeled A will be shut off and replaced with alternate water outlet/faucet M pending retesting At the present time water outlet/faucet M is currently not in use, The water/faucet outlet labeled A will be shut off and replaced

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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: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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