191600175-9-21-2022-30-CC-KSCT-CJGS4R-20220921133309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600175
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:33:25 PM

Document Has Been Signed on 09/21/2022 01:33 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	COVENANT PRESBYTERIAN CHURCH PRESCHOOL		FACILITY NUMBER:	191600175
ADMINISTRATOR:	SULTAN, KATHLEEN		FACILITY TYPE:	850
ADDRESS:	6323 WEST 80 STREET		TELEPHONE:	(310) 670-5758
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	74	CENSUS: 56	DATE:	09/21/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Kathleen Sultan		TIME COMPLETED:	01:50 PM

NARRATIVE

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Licensing Program Analyst (LPA), Keyona Scott, conducted a Case Management Deficiency inspection on 09/21/2022. LPA met with Director, Kathleen Sultan at 11:20 AM. This is a preschool program that serves children ages two and a half (2.5) years old to five (5) years old. LPA toured the facility. LPA observed the proper teacher to children ratios upon arrival with 56 children in care to eight (8) staff. All Adults working and/or volunteering at the facility have a criminal record clearance or exemption.

LPA explained to Director that the El Segundo Child Care Regional Office (ESCCRO), received testing results of lead Action Level Exceedance (ALE) for three different water outlets at the facility. Per the results received, the ALE was over five (5) parts per billion; this is a potential risk to the health and safety of the children in care.

Per Director five faucet outlets in five different locations of the preschool were tested: Faucet A located in room 1 (Bunnies classroom); faucet B located in room 2 (Teddies classroom); faucet C located in room 3 (Koalas classroom); faucet D located in room 4 (Dolphins classroom); faucet E located in the kitchen. Director lead LPA on tour of facility to review all other faucets at the preschool that were not included in the lead testing. LPA observed four bathrooms in the preschool that were not tested by the water sampling company. The bathrooms are located in the classrooms: one sink in the bathroom in room 1 (Bunnies) two (2) sinks in the bathroom that is shared with room 2 (Teddies) and room 3 (Koalas); one sink in the bathroom that is shared with room 4 (Dolphins) and room 5 (Butterflies). There is no sink located in room 5 (Butterflies). Per Director, the faucets in the classrooms are not used for food preparation or drinking water and only used for cleaning and arts and crafts purposes; however, when verified with water sampling company was advised to also test the classrooms that have sinks.

LPA advised and Director confirmed per results received water sampling company that faucet outlets A, B and C have Active Lead Exceedance.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COVENANT PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 191600175
	VISIT DATE: 09/21/2022

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During tour LPA observed faucets A, B, C covered and a sign placed over each faucet that states Do Not Use For Drinking Water Or Food Prep Until Further Notice (pictures taken of each faucet A B, C by LPA). Faucets A, B, C in the classrooms are unreachable and inaccessible to children in care.

Per Director, arrangements are in process to replace the faucets A, B, C and received approval today by the Church Chair of Facilities Committee to move forward with repairs and contact plumber to begin replacement process. Director states will contact Westchester Plumbing to begin replacement process.

LPA has advised Director and verified that the lead testing results are to be posted on the parent board.

LPA provided Director with a copy of the following:

· PIN 21-21-CCP: Release of Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB2370

· PIN 22-06-CCP: Lead Testing in Child Care Centers- Frequently Asked Questions

· LIC 9276 Child Care Center Sampling Checklist Form

LPA advised Director to refer to page 5 on LIC 9276: Follow-up checklist for water sampling during a Corrective Action Plan

This checklist is for Child Care Centers to use during a water sampling after a Lead Action Level Exceedance has been detected and remediation has taken place.

Per the Written Directives for Lead Testing of Water in Licensed Child Care Centers, AB 2370; deficiency cited. (See LIC 809D).

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Kathleen Sultan.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/21/2022 01:33 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COVENANT PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 191600175
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 11/07/2022 Section Cited	1 2 3 4 5 6 7	101700.3(b)(1) (b)Testing results with fractional ppb readings of 0.5 ppb or greater... (1) A result with values 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by:
	8 9 10 11 12 13 14	The Action Level Exceedance result values were greater than 5.5 ppb for three out of five of the faucet outlets that were tested for the preschool, if not corrected this poses a potential Health and Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14	and receives new sampling testing results to provide LPA with a copy of the new results. LPA has provided facility six weeks, until 11/07/2022 to make corrections and provide results.
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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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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