197402430-1-18-2023-58-CC-DMIA-CN7P2K-20230118095602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402430
Report Date: 01/18/2023
Date Signed: 01/18/2023 09:56:08 AM

Document Has Been Signed on 01/18/2023 09:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SHERMAN OAKS NEIGHBORHOOD SCHOOL INC.		FACILITY NUMBER:	197402430
ADMINISTRATOR:	PATTY LUDWIG		FACILITY TYPE:	850
ADDRESS:	4433 MAMMOTH AVE.		TELEPHONE:	(818) 783-7289
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91423
CAPACITY:	32	CENSUS: 31	DATE:	01/18/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Kaleigh Salamanca, LeadTeacher, Designated Person and Patty Ludwig, Director		TIME COMPLETED:	10:00 AM

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On 01/18/2023 at 8:15 am Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced case management visit - Lead Testing/Exceedance. LPA Miranda was greeted by Lead Teacher Kaleigh Salamanca, and granted entry into the facility. Lead Teacher guided LPA Miranda on a tour of the facility. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedances (ALE) and conduct an inspection.

There are 5 staff and no children present upon arrival. Per Lead Teacher, children starting to arrive around 9:50am. At 8:40am Patty Ludwig, Director arrived at the facility. LPA informed the purpose of the visit. At 9:30am LPA observed 5 staff with 31 children present.

Community Care Licensing Department was notified of the results of the Lead Water Testing conducted at the facility on 12/17/2022. The sample test for the fountain (B), located at the playground area/outdoor, identified on the facility sketch by number “B” , tested at 77 bbp/ug L, which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

During today’s visit LPA observed fountain identified on facility sketch (B). LPA observed the fountain inoperable; the fountain has a tape “not in used” and the water was shut-off, facility is providing filter water to the children in care. The Director has plan to remove the fountain from the outdoor area. Director contacted the Lead test company regarding the next steps that she shall take.

Facility received copy of the Water testing report on 01/17/2023 and Director has posted testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, facility will report to the parents and families to view at the facility within 24 hours of receiving the results from the Department. Facility will notify all parents or guardians of children in care of Lead Exceedance results and what has been done to date and remediation plan for water fountain “B”. Proof of the notification to the parents will be submit to

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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: SHERMAN OAKS NEIGHBORHOOD SCHOOL INC.	FACILITY NUMBER: 197402430
	VISIT DATE: 01/18/2023

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LPA via email.

During today’s visit LPA took pictures of the water fountain (B). On 01/17/2023, LPA received an email from the facility with copies; Child Care Center Sampling Checklist Form (LIC 9276); Facility Sketch (LIC 999) in which all water outlets are noted; and copy of water testing results.

During this visit, Director sent an email to LPA with a copy copy of External Water Sampler Self-Certification Form (LIC 9275), and LIC9276 Child Care Center Sampling Checklist Form signed by the Certified External Water Sampler.

During today’s visit one Type B violation is being issued per PIN 21-21-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.

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 will email to the Director with the Provider Information Notice (PIN) 21-21CCP 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 (LIC809 & LIC809d), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to Director Patty Ludwig.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/18/2023 09:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHERMAN OAKS NEIGHBORHOOD SCHOOL INC.	FACILITY NUMBER: 197402430
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/19/2023 Section Cited	1 2 3 4 5 6 7	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. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The facility will keep the fountain inoperable; the fountain (B) has a tape “not in used” and the water was shut-off. Per Director she will remove the fountain no later than today (01/19/2023) and contact the Water Testing Company to report their action. Photos of the fountain removed will submit to LPA Miranda no later tomorrow 01/19/2023 and Director will email to LPA the next step that the Water Company provided to her.
	8 9 10 11 12 13 14	Based on observation, interview and record review, The facility water fountain (B) tested at 77 bbp/ug L, which exceeds allowable limit for Lead, which poses a potential Health or Safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	Facility will notify all parents or guardians of children in care of Lead Exceedance results and what has been done to date and remediation plan for water fountain “B” . Copy of the notification will submit via email to LPA no later than today. In
	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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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