<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202174
Report Date: 03/23/2023
Date Signed: 03/23/2023 09:49:22 AM


Document Has Been Signed on 03/23/2023 09:49 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:VILLAGE NURSERY SCHOOLFACILITY NUMBER:
191202174
ADMINISTRATOR:BRIDGET CANTRELLFACILITY TYPE:
850
ADDRESS:3306 WEST VICTORY BOULEVARDTELEPHONE:
8188435766
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:65CENSUS: 63DATE:
03/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Karine Zeytunyan, Director and Bridgte Cantrell. Executive Director TIME COMPLETED:
09:55 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/23/2023 at 7:55 A.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 Karine Zeytunyan, Director and Bridget Cantrell, Director, and toured the facility. During today’s visit there are 22 children and 4 teachers. Risk Assessment was conducted prior to conducting site visit.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 12/28/2022. The sample test for the sink faucet, located in Room#4 , identified on the facility sketch by letter “F”, tested at 6.1 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 that Facility removed the drinking fountain from the sink area, located in the room#4, identified on the facility sketch by letter "F".

Facility is providing spring drinking water for the children to drink. Facility has 5 gallons of water available to the children in care located at the room#4.

Director has posted testing results, in a location (Director’s 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 will notify today 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 “F". During today’s visit LPA took pictures of the location of the water sink – fountain (F). LPA received via email copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276);

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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 3


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: VILLAGE NURSERY SCHOOL
FACILITY NUMBER: 191202174
VISIT DATE: 03/23/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Facility Sketch (LIC 999) in which all water outlets are noted; and copy of water testing results summary.

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 (LIC809 & LIC809D), Appeal Rights (LIC9058), and Notice of Site Visit (LIC9213) were reviewed and provided to Bridget Cantrell, Director.

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/23/2023 09:49 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: VILLAGE NURSERY SCHOOL
FACILITY NUMBER: 191202174

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
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
Facility removed from the sink area (“F”) the drinking fountain, located at the room#4. LPA obtained pictures of the sink area (“F”) the drinking fountain. Facility will notify today 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 “F".
8
9
10
11
12
13
14
Based on observation, interview and record review, The facility water sink – fountain (F) test with Lead Exceedance results (6.1 ppb). This poses a potential health & safety risk to the children in care.
8
9
10
11
12
13
14
Director will send a copy of the email to LPA that was sent to the parents or guardians of children in care. Director will revise the facility sketch showing Room#4, sink faucet “F” has a drinking fountain. LPA will contact the lab technician and request to revise the lead report showing the sink faucet “F”, has a drinking fountain. Director will submit to LPA via email no later than 04/03/2023.

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 RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3