191202133-4-4-2023-58-CC-DMIA-CQKM5X-20230404091904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202133
Report Date: 03/30/2023
Date Signed: 04/04/2023 09:19:18 AM

Document Has Been Signed on 04/04/2023 09:19 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	TEMPLE BETH HILLEL NURSERY SCHOOL		FACILITY NUMBER:	191202133
ADMINISTRATOR:	CLAUDINE DOUGLAS		FACILITY TYPE:	850
ADDRESS:	12326 RIVERSIDE DRIVE		TELEPHONE:	(818) 763-9148
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	140	CENSUS: 100	DATE:	03/30/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Claudine Douglas, Director		TIME COMPLETED:	01:10 PM

NARRATIVE

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On 03/30/2023 at 8:20A.M., Denise Miranda, Licensing Program Analyst (LPA), conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Claudine Douglas, Director, and toured the facility.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 01/03/2023. The sample test for the sink faucet, located in the kitchen area (classroom#11), identified on the facility sketch by letter “c” tested at 62 ppb/ug L, which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

LPA observed the area of sink located in the kitchen area (classroom#11), facility placed a signed “ out of service – do not use until remove by sample” with yellow tape.

Facility re-sample on 03/11/2023, and received the results test at 21 ppb/ug L. Per Director classroom#11 in not in use.

Director has posted testing results, in a location main office 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 within 24 hours of receiving the results from the Department. Facility has notified all parents or guardians of children in care of Lead Exceedance results and what has been done to date and remediation plan for water outlet “c”.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: TEMPLE BETH HILLEL NURSERY SCHOOL	FACILITY NUMBER: 191202133
	VISIT DATE: 03/30/2023

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During today’s visit LPA took pictures of the location of the water faucet (C).

On 02/22/2023 LPA received via email 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 copy of water testing results summary and during this visit facility provided a copy of re-testing sample results summary on 3/16/2023.

During today’s visit one Type B violation is being issued per PIN 21-21-CCP, Title 22 Regulations, Division 12, and Subchapter 5: 101700.3(b)(1) California Lead Action Level at Child Care Centers: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

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.

For more information, go to the California Childhood. Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb or call them at (510) 620-5600. LPA will email and provide the Director with the Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions.

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.

A copy of this Report with plan of correction were reviewed and provided to Claudine Douglas, Director.

Note: type version of a handwriting LIC809, left at facility. Director will receive computerized report in the mail.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/04/2023 09:19 AM - 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: TEMPLE BETH HILLEL NURSERY SCHOOL	FACILITY NUMBER: 191202133
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/21/2023 Section Cited	1 2 3 4 5 6 7	101700.3(b)(1) California Lead Action Level at Child Care Centers - A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement not met as evidence by:	1 2 3 4 5 6 7	During this visit, Director contacted the the Lab-manager to address the discrenpance o nthe re-testing report received on 3/30/23, that sample was collected on 3/14/2023.
	8 9 10 11 12 13 14	Based on observation, interview and record review, The facility water sink – fountain (c) test with Lead Exceedance results (62 ppb/ugl). This poses a potential health & safety risk to the children in care.	8 9 10 11 12 13 14	Per director the lab manager will conducte a re-testing(dated no provided). LPA observed that facility maintained "off-limit the sink "c", located in the class#11. Director will follow up with lab manager regarding the new re-testing results. Direcor will submit a copy of the new re-testing via email to LPA alont with facility correction no later than 4/21/23.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

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