191600684-9-21-2022-30-CC-LPHS-CJGSRJ-20220921140624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600684
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:06:49 PM

Document Has Been Signed on 09/21/2022 02:06 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:	FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL		FACILITY NUMBER:	191600684
ADMINISTRATOR:	NANCY J. DURKOVIC		FACILITY TYPE:	850
ADDRESS:	1100 POINSETTIA AVE.		TELEPHONE:	(310) 545-5653
CITY:	MANHATTAN BEACH	STATE: CA	ZIP CODE:	90266
CAPACITY:	125	CENSUS: 109	DATE:	09/21/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	April Lang, Support Staff		TIME COMPLETED:	02:15 PM

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On 09/21/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced case management - deficiencies visit. LPA was met by Support Staff, April Lang. LPA toured the facility and observed 109 children in care with 16 staff.

LPA explained the purpose of the visit. The department has received testing results, indicating 3 water outlets have been identified with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5 ppb, or greater.

During today’s inspection, LPA obtained the following documents: Child Care Center Sampling Checklist Form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275) Facility Sketch labeled with locations of all water outlets that were tested, Parents notification and Plan of Correction.

LPA observed the 3 water outlets that has ALE. Outlet A is located in the Altar Guild room located in the church. Children in care do not access this area. Outlet I is located in classroom 6 (green room) and outlet J is located in classroom 7 (purple room). The outlets were labeled with signs that states "Please immediately cease using this water outlet for drinking water or food preparation until directed otherwise". LPA took photos and verified that the outlets were identified on the facility sketch. Support Staff stated that the 2 classrooms do not drink from water outlets and do not use water for food preparation. Support Staff stated both classrooms use Sparkletts Drinking water and that water is poured into a Britta filter water pitcher for drinking. Children and staff will discontinue using water outlets for hand washing. Drinking water is available indoors and outdoors for children in care.

Support staff stated the facility has notified all parents via email and posted the Lead Testing Results on the parent board. LIC 809-C

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
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: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
	VISIT DATE: 09/21/2022

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Lead water testing samples collected on 08/20/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Per the Written Directives for Lead Testing of Water in Licensed Child Care Center, AB 2370 the following deficiency is cited (See next page 809-D).

For more information, go to the California Childhood. Lead Poisoning Prevention Branc's website at www.cdph.ca.gov/programs/clppb Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention

An Exit interview conducted and appeal right explained. A copy of this report, appeal rights, and Notice of Site Visit provided to April Lang.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
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 02:06 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: FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOL	FACILITY NUMBER: 191600684
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/05/2022 Section Cited	1 2 3 4 5 6 7	101700.3(b)(1) California Lead Action at Child Care Centers (b)Testing results with fractional ppb readings....(1) A result of 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by the Action Level Exceedance results revealed
	8 9 10 11 12 13 14	that levels of lead were beyond allowable amount deemed by the State of California, 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
	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: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
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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