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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191690081
Report Date: 05/03/2023
Date Signed: 05/03/2023 01:26:19 PM


Document Has Been Signed on 05/03/2023 01:26 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:SINAI TEMPLE AKIBA PRE-SCHOOLFACILITY NUMBER:
191690081
ADMINISTRATOR:SARAH KLINGERFACILITY TYPE:
850
ADDRESS:10400 WILSHIRE BLVD.TELEPHONE:
(310) 481-3270
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:259CENSUS: DATE:
05/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kendell Parie, Operations ManagerTIME COMPLETED:
01:45 PM
NARRATIVE
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On 05/03/2023 at 10:45 AM, Maria Rendon and Antonio Almanza, Licensing Program Analysts (LPAs) conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), facility inspection. LPA met with Kendell Parie, Operations Manager and April Schafer, Director of Admissions and toured the facility. During today’s visit LPA's observed 59 children and 12 teachers.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 03/13/2023. The facility has seven water outlets (OO), (RR), (KK), (VV), (J), (F), and (XX) with lead exceedances of 26, 8.3, 7.8, 7.3, 6.1, 5.9, and 5.8, respectively. Test samples testing over 5.5 ppb and above is considered an exceedance.

LPA's observed the 2 water fountains (VV and XX), located in the back patio, capped and removed from service.

Facility is reporting that the 5 water fountains OO, RR, KK, J, and F locate in classrooms 81, 83, 77, 60 and 57, respectively, have been replaced, are not in use and are pending retesting. LPA's observed the water outlets covered with “Do Not Use Until Removed by Sampler” notice. Facility is providing water bottles and or using drinking fountains in the yard.

SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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 4


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: SINAI TEMPLE AKIBA PRE-SCHOOL
FACILITY NUMBER: 191690081
VISIT DATE: 05/03/2023
NARRATIVE
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Facility has posted lead testing results, in a location (facility lobby) 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. On 04/23/23, facility notified parents or guardians of children in care of lead exceedance results and what has been done to date and remediation plan for water outlet OO), (RR), (KK), (VV), (J), (F), and (XX).

LPA's took pictures of the water outlets (OO), (RR), (KK), (VV), (J), (F), and (XX). LPA's 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.

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.

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

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SINAI TEMPLE AKIBA PRE-SCHOOL
FACILITY NUMBER: 191690081
VISIT DATE: 05/03/2023
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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 facility 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 (LIC809s & LIC809D), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to Kendell Parie, Operations Manager and April Schafer, Director of Admissions.

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

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 05/03/2023 01:26 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: SINAI TEMPLE AKIBA PRE-SCHOOL
FACILITY NUMBER: 191690081

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
Section Cited

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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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2 water fountains (VV and XX), located in the back patio have been capped and removed from service.
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Based on observation, interview and record review, facility has seven water outlets (OO), (RR), (KK), (VV), (J), (F), and (XX) with lead exceedances , which poses a potential Health or Safety, or personal rights risk to persons in care.
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5 water fountains OO, RR, KK, J, and F have been replaced, are not in use, and are pending retesting.

Facility agrees to have outlets retested by 05/31/23.

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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: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4