197400783-3-1-2023-30-CC-DWHE-CPHRMK-20230301120851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197400783
Report Date: 03/01/2023
Date Signed: 03/01/2023 12:08:58 PM

Document Has Been Signed on 03/01/2023 12:08 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:	CCRC HEAD START - WOODMAN		FACILITY NUMBER:	197400783
ADMINISTRATOR:	HEATHER STRAUSS		FACILITY TYPE:	850
ADDRESS:	5944/5939/WOODMAN/BUFFALO AVE.		TELEPHONE:	(818) 989-2379
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	120	CENSUS: 51	DATE:	03/01/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Siranush Andakyan		TIME COMPLETED:	12:03 PM

NARRATIVE

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On 03/01/2023 Licensing Program Analyst (LPA) Doris Whitmore arrived at CCRC Wood man Headstart Center to conduct an unannounced case management visit. LPA Whitmore was met by Center Director Siranush Andakyan . LPA Whitmore informed Center Director about the purpose of the visit and was guided on a tour of the facility. There were 12 teachers and 51 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.

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

On 02/15/2023, Early Learning Supervisor Heather Strauss emailed LPA Whitmore the following documents: facility sketch, action items in place pictures of fixtures, report of test results, On 02/28/2023 Heather Strauss emailed LPA Whitmore External Water Sampler Self- Certification form( LIC9275) Child Care Sampling Checklist form( LIC9276), letter to parents, Lead Water sample testing conducted by L.A.Testing. The facility was prep for water sampling on 01/25/2023, tested 01/26/2023. The lab collected the water sample on 01/25/2023. The facility received the results on 02/14/2023. Samples submitted to the L.A. Testing. Per the report, the following water outlets yielded the following reports:

Room 5 Handwashing Sink G ppb.5.69

Room 6 Handwashing Sink D ppb.5.84

During tody's visit LPA observed that the facility currently does not used the handwashing sinks in Room 5 and Room 6. LPA observed the handwashing sinks with a sign that says Don't use the sink.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CCRC HEAD START - WOODMAN	FACILITY NUMBER: 197400783
	VISIT DATE: 03/01/2023

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LPA observed that the sinks were changed and currently in both classrooms the children are using a Portable sink. LPA Whitmore observed in classroom 5 and 6 water dispensers. Sinks will be tested again after 02/15/2023. Currently Room 6 is not being used as a classroom there are no children

LPA will upload documents to the CA State Control Board, Division of Drinking Water (DDW) data base. During today's visit LPA Whitmore conducted the tour of the facility and observed the two handwashing sinks. LPA took pictures of the handwashing sinks.

Based on observation, interviews and supportive documents it has been determined that CCRC Valero Headstart l violated Child Care Licensing Regulation Division 12 Chapter 1, Subchapter 5 1017003 (b) (1) California Lead Action Level at Child Care Centers. A result with values of 5.5ppb or greater shall be deemed an Action Level Exceedance. Lead water testing samples taken on 01/25/2023 reveled that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during todays visit 03/01/2023. This is a type B violation which poses a potential Health, Safety, or Personal Rights risk to persons in care. Refer to LIC809-D for deficiency page.

LPA discussed Proof of Correction (POC) with Early Learning Supervisor Heather Strauss

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 was conducted with Siranush Andakyan Center Director report was given along with the appeal rights and notice of Site Visit.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/01/2023 12:08 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: CCRC HEAD START - WOODMAN	FACILITY NUMBER: 197400783
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/01/2023 Section Cited	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers A result with values of 5.5ppb or gretaer shall be deemed an Action Level Exeedance. This requirement is not met as evidence by Lead Water Testing Samples taken on 01/25/202 revealed levels of lead.	1 2 3 4 5 6 7	Early Learning Supervisor Heather Stratuss via emailed LPA Whitmore on 02/15/2023 Action Items in place and completed already, Closed out sinks located in classsrooms and covered them. Brought in Portable sinks until new sinks are iinstalled new sinks were insatlled and observed at the time of visit Parents have been notified by letter.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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