191610282-4-4-2023-58-CC-SORS-CQKRGU-20230404130120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191610282
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:01:30 PM

Document Has Been Signed on 04/04/2023 01:01 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 CENTER - INFANTS		FACILITY NUMBER:	191610282
ADMINISTRATOR:	ALICIA MINOR BROWN		FACILITY TYPE:	830
ADDRESS:	10620 SUNSET BLVD.		TELEPHONE:	(310) 825-2900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90095
CAPACITY:	26	CENSUS: 24	DATE:	04/04/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	ALICIA MINOR BROWN - DIrector ; Marcia Martinez - Director		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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 24 children and 8 adults during today’s visit. The facility has been identified to have 1 water outlet 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. Per the report, the following water outlets yielded the following results: 1.) Faucet A - Room 172 (Hose Spigot - Pink Room Yard): 14 ppb Per documentation obtained: Note, the incorrect labeling was used for the area. The items listed are for facility number 191610282. During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet/outdoor hose spigot that was bagged and taped. Not used for food prep or consumption. LPA obtained photos of water outlet that was identified on the facility sketch.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 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 - INFANTS	FACILITY NUMBER: 191610282
	VISIT DATE: 04/04/2023

NARRATIVE

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Director stated that the children do not consume water from the water outlet. 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 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility was previously cited on 12/15/2022.

LPA discussed Proof of Correction (POC) with Directors. Directors stated fixture has been replaced; however, retest has yet to be conducted .Director further stated that once retest results are obtained, Director will email results 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. A copy of this report, appeal rights, and Notice of Site Visit provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 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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