197402309-3-1-2023-30-CC-DWHE-CPHPAP-20230301100905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402309
Report Date: 01/12/2023
Date Signed: 03/01/2023 10:09:18 AM

Document Has Been Signed on 03/01/2023 10:09 AM - 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 - VALERIO		FACILITY NUMBER:	197402309
ADMINISTRATOR:	PHUNG PHAM		FACILITY TYPE:	850
ADDRESS:	15035 VALERIO STREET		TELEPHONE:	(818) 786-3427
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	41	CENSUS: 34	DATE:	01/12/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Phung Pham		TIME COMPLETED:	02:47 PM

NARRATIVE

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On 01/20/23 Licensing Program Analyst (LPA) Doris Whitmore arrived at CCRC Valerio Headstart Center to conduct an unannounced case management visit. LPA Whitmore was met by Center Director Phung Pham. LPA Whitmore informed Center Director about the purpose of the visit and was guided on a tour of the facility. There were 6 teachers and 24 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 01/05/2023, Early Learning Supervisor Lizette Ortiz/ Early Headstart Headstart emailed LPA Whitmore the following documents: facility sketch, pictures of fixtures,test results, External Water Sampler Self- Certification form( LIC9275) Child Care Sampling Checklist form( LIC9276), LA Testing order form, Lead Water sample testing conducted by L.A.Testing. The facility was prep for water sampling on 12/12/202, tested 12/13/2022. The lab collected the water sample on 12/14/2022. The facility received the results on 01/04/2023. Samples submitted to the L.A. Testing. Per the report, the following water outlets yielded the following reports:

Handwashing Sink A ppb.16.6

Handwashing Sink D ppb13.7

During tody's LPA observed that the facility does not used the handwashing sinks for food preparation or drinking water. Children have bottled water.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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 - VALERIO	FACILITY NUMBER: 197402309
	VISIT DATE: 01/12/2023

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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 12/13/2022 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 01/12/2023. 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 Center Director Phung Pham and Early Learning Supervisor Early HeadStart/ Headstart Lizette Ortiz

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, report was reviewed with Center Phung Pham licensee was provided a copy of the report and appeal rights.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/01/2023 10:09 AM - 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 - VALERIO	FACILITY NUMBER: 197402309
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/26/2023 Section Cited	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers. A result with values of 5.5.ppb or greater shall be deemed an Action level Exceeedance. This requirement is not met as eveidence by: Lead water testing samples taken on 12/13/2022 revealed the levels of lead.	1 2 3 4 5 6 7	Early Learning Supervisor Early HeadStart/ Head Start via email closed out the sinks located in the classrooms and cover them. Children and staff will use the bathroom sinks CCRC has brought in water bottled water as a 2nd option to out filter water. CCRC Facilities Dept. are looking in replacing the faucets.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14	Parent will be provided a letter informing then the levels of the faucet and the following steps to be corrected. None of the handwashing sinks are used for food preparation or drinking water. Follow up testing will be done along with a written directive.
	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: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

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