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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603520
Report Date: 09/13/2022
Date Signed: 09/14/2022 12:40:28 PM


Document Has Been Signed on 09/14/2022 12:40 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:TEMPLE AKIBA OF CULVER CITYFACILITY NUMBER:
191603520
ADMINISTRATOR:BISHOFF, RANDEEFACILITY TYPE:
850
ADDRESS:5249 S. SEPULVEDA BLVD.TELEPHONE:
(310) 398-5783
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:90CENSUS: 74DATE:
09/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director, Randee Bishoff TIME COMPLETED:
04:30 PM
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On 9/13/2022 Licensing Program Analyst (LPA) Dalicia Adkins conducted an unannounced case management visit. LPA Adkins was greeted by director Randee Bishoff and granted entry into the facility. Director guided LPA Adkins on a tour of the facility. There were 12 teachers and 74 children present during the visit.

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.

Community Care Licensing was notified that lead water testing conducted at the facility on 8/16/2022 exceeded allowable limit for lead. Samples testing over 5.5 ppb/ug L and above is considered an exceedance. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedances (ALE) and conduct an inspection.

During today’s visit LPA Adkins observed water facet/outlets identified on facility sketch. LPA Adkins confirmed with director that outlet O and L samples were identified as exceedance of lead and shall remain inoperable. LPA observed outlet L drinking water fountain located in the hallway. This drinking water fountain was observed to be inoperable; fountain covered, and children did not have access to fountain. Fountain is disconnect and no running water. Per director this is not being used and has not been used in the last three years. LPA observed outlet O faucet/outlet located in the storage room. Per director this outlet is used for washing hands only and was not used for consumption. Per director, facility ceased the use of facet/outlet O. LPA observed faucet/outlet O and L covered with plastic and labeled not in use.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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: TEMPLE AKIBA OF CULVER CITY
FACILITY NUMBER: 191603520
VISIT DATE: 09/13/2022
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During today’s visit LPA Adkins collected copies of LIC 9275, LIC 9276, Facility Sketch (water faucets/outlets identified) and copy of water testing results summary. LPA Adkins took pictures of faucets/ outlets.

Per director children bring their own water bottles and water bottles are re-filled with filtered water. Per director meals are provided by parents and facility provide snacks. Meal are not prepared at the center.

Based on observation, interviews and sampling records it has been determined that there was a violation of Licensing Regulation Title Division 12, Chapter 1- Physical Plant, Building and Grounds -Section 101238 (a) The Child Care Center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Lead water testing samples taken on 8/16/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Water fountain (sample L) lead exceedance level 140 ug/L and faucet/outlet (sample O) in classroom lead exceedance level 8.2 ug/L. This facility is being cited (1) deficiency during today’s visit 9/13/2022. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. In Accordance with California Code of Regulations. Refer to LIC 809-D.

LPA discussed Proof of Correction (POC) with Director. Director agreed to cease the use of outlet/faucet L and O. These outlets will not be accessible for use. Notification of letter will be sent out to parents with notification of cease of water outlets and remediation for planned for water outlets or alternative. Director will send LPA a copy of the letter via email by 9/15/2022.

Per director required licensing forms submitted on 8/17/2022 for child care center assistance program for lead in drinking water is pending. Director will follow up with California Rural Water Association. Director will get guidance and next appropriate and final step will be to remove faucet/outlet. And drinking water faucet/ outlet (L) will be removed from the facility. Director will follow up with LPA.

Instructions for required lead testing are outlined in PIN 21-21. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: TEMPLE AKIBA OF CULVER CITY
FACILITY NUMBER: 191603520
VISIT DATE: 09/13/2022
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Care Child Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in a parts per billion (ppb) unit of measurement.

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. Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention

LPA Adkins provided technical assistance and discussed wavier for drinking water as outlined in PIN 21-21-CCP.

Exit interview conducted and appeal right explained. This report reviewed with licensee and copy provided.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 09/14/2022 12:40 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: TEMPLE AKIBA OF CULVER CITY
FACILITY NUMBER: 191603520

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2022
Section Cited

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101238 Buildings and Grounds (a) The Child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well being of children , employee and visitors: This requirement not met as evidence by:
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Lead water testing samples taken on 8/16/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Water fountain (sample L) lead exceedance level 140 ug/L and faucet/outlet (sample O) in classroom lead exceedance level 8.2 ug/L. This poses a potential health and safety risk to children in care.
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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: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4