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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600528
Report Date: 03/03/2023
Date Signed: 03/03/2023 03:04:08 PM


Document Has Been Signed on 03/03/2023 03:04 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:PALISADES PRESBYTERIAN PRESCHOOLFACILITY NUMBER:
191600528
ADMINISTRATOR:JULIE BACZEWSKIFACILITY TYPE:
850
ADDRESS:15821 SUNSET BLVDTELEPHONE:
(310) 454-0737
CITY:PACIFIC PALISADESSTATE: CAZIP CODE:
90272
CAPACITY:90CENSUS: 52DATE:
03/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Director Julie BaczewskiTIME COMPLETED:
11:20 AM
NARRATIVE
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On 03/23/2023 at 09:20 AM, Antonio Almanza, 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 Julie Baczewski, Director and toured the facility. During today’s visit there are 52 children and 10 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 12/20/2022, identified water outlets “F” and “F30” with lead exceedance of 17 and 8.5 respectively. The sample test for the Water Faucet located in the Purple Room, identified on the facility sketch by letter “F”, tested at 8.5 bbp/ug L, exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance. The Results from the Lead testing company Enthalpy Analytical identifies Water Faucet “F” as “F” Sink Faucet and “F” Sink Faucet Flushed.

During today’s visit LPA observed the Water Faucet located in the Purple Room, covered with a plastic bag and “Do not use until removed by sampler” sign. The Director is reporting that the water Faucet was replaced on 09/08/2022 prior to the Lead Water Test sample date. On 03/03/23, the Director had a Zoom meeting with Office of Water Programs (OWP), located in California State University of Sacramento, to discuss the Lead Water Testing results and how to remediate the lead exceedance. Director was recommended to add a “Lead Filter” and then retest Water Faucet. Director will provide written documentation from meeting held today with OWP explaining that only one Water Faucet “F” was sampled and Water Faucet “F30” is the same Water Faucet flushed for 30 seconds.

Licensee has posted Lead testing results, in a location (office/classrooms) 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. Pg 1 of 3

SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
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: PALISADES PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 191600528
VISIT DATE: 03/03/2023
NARRATIVE
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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 “F”.

During today’s visit LPA took pictures of the water outlet “F”. LPA received 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 was provided.

During today’s visit one Type B violation is being issued per PIN 21-21.1-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 emailed and provided the Director with the Provider Information Notice (PIN) 21-21.1 CCP 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 the Director Julie Baczewski.

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SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:

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

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/03/2023 03:04 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: PALISADES PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 191600528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/31/2023
Section Cited

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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 is not met as evidenced by:
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Director agrees to provide LPA with written Documentation from Office of Water Programs (OWP)identifying water faucet "F" and "F30 as the same faucet.
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Based on observation, interview and record review, water outlets “F” and “F30” with lead exceedance of 17 and 8.5 respectively is considered an exceedance, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Director agrees to have water filter installed per OWPs guidance and retested by 03/31/23.

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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: Betty BellTELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
LIC809 (FAS) - (06/04)
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