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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610280
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:04:24 PM


Document Has Been Signed on 04/04/2023 01:04 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:FERNALD CHILD CARE CENTERFACILITY NUMBER:
191610280
ADMINISTRATOR:ALICIA MINOR BROWNFACILITY TYPE:
850
ADDRESS:320 CHARLES YOUNG DRIVE NORTHTELEPHONE:
(310) 825-2900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY:36CENSUS: 31DATE:
04/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:ALICIA MINOR BROWN - Director;
Marcia Martinez, Diector		TIME COMPLETED:
01:30 PM
NARRATIVE
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On 04/04/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at FERNALD CHILD CARE CENTER to conduct an unannounced case management visit. LPA Ornelas was met by Director, ALICIA MINOR BROWN and Director of Operations, Marcia Martinez. LPA informed director about the purpose of the visit and was guided on a tour of the facility. LPA observed 31 children and 7 adults during today’s visit.

The facility has been identified to have 2 water outlets with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility.

On 03/30/2023, LPA Ornelas contacted the facility; however, call went to voicemail and LPA was unable to obtain the following documents from director via email: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets).

On 4/4/2023, Director provided LPA with a copy of the results of lead water sample testing conducted on 10/20/2022 as well as retesting that was conducted on 02/14/2023. Per the retest report, the following water outlets yielded the following results:

1.) Faucet J - Outdoor Sandbox (Hose Spigot - Big Yard): 6.6 ppb
2.) Faucet N - Behind Yellow Building (Hose Spigot - Lab School Side Yard): 7.7 ppb

Per documentation obtained: Note, the incorrect labeling was used for the area. The items listed are for facility number 191610280.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FERNALD CHILD CARE CENTER
FACILITY NUMBER: 191610280
VISIT DATE: 04/04/2023
NARRATIVE
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During today’s visit LPA Ornelas conducted a tour of the facility and observed 2 water outlet/outdoor hose spigots that were bagged and taped. Not used for food prep or consumption. LPA obtained photos of water outlets that were identified on the facility sketch. Directors stated that the children do not consume water from the water outlets. LPA observed Water Dispensers in the classroom where children can access water, Director stated that Arrowhead provides delivery service every two weeks.

Based on observation, interviews and supportive documents it has been determined that FERNALD CHILD CARE CENTER violated Child Care Licensing Regulation Division 12, Chapter 1, 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.

Lead water testing samples taken on 10/20/2022 and 02/14/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during today’s visit 04/04/2023. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page.

LPA discussed Proof of Correction (POC) with Directors. Directors stated fixtures have been replaced and retested; however, due to retest showing a lead exceedance once again, new stainless steel part has been ordered for Faucet J and is anticipated to arrive in approximately 2-3 weeks. Per Director, Faucet N will be capped off and removed. Director further stated that once retest results are obtained, results will be emailed to LPA. As mentioned earlier, Director submitted all required licensing forms, supportive documents and provided LPA with a Plan of Correction Date of 07/31/2023.

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.

Exit interview conducted and appeal rights explained. A copy of this report, appeal rights, and Notice of Site
Visit provided to Director.

suzette.ornelas@dss.ca.gov
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2023 01:04 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: FERNALD CHILD CARE CENTER
FACILITY NUMBER: 191610280

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2023
Section Cited

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101700.3 California Lead Action Level at Child Care CentersTesting r (b)results with fractional ppb readings of 5.0 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.
(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was met as evidency by
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Director stated that parts have been ordered and will be replaced or capped off and removed. Oonce retest results are obtained, results will be emailed to LPA. Faucets with lead exceedance are outdoor hose spigots and are not used for food prep or consumption. Plan of Correction Date of 07/31/2023.
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Lead water testing samples taken on 10/20/2022 and retested on 02/14/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. Faucet N lead exceedance level tested at 7.7 ug/L and Faucet J lead exceedance tested at 6.6. 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: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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