197407687-11-22-2022-30-CC-JLAO-CLERT4-20221122121744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197407687
Report Date: 11/03/2022
Date Signed: 11/22/2022 12:18:06 PM

Document Has Been Signed on 11/22/2022 12:18 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:	SALVATION ARMY BESSIE PREGERSON CHILDCARE, THE		FACILITY NUMBER:	197407687
ADMINISTRATOR:	GUADALUPE PLACENCIA		FACILITY TYPE:	850
ADDRESS:	1341 SOUTH SEPULVEDA		TELEPHONE:	(310) 477-2772
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90025
CAPACITY:	60	CENSUS: 20	DATE:	11/03/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Guadalupe Placencia		TIME COMPLETED:	10:30 AM

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 11/3/2022, Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced case management visit. LPA Laureano was greeted by director Guadalupe Placencia, facility director and granted entry into the facility. Director guided LPA Laureano on a tour of the facility. There were 5 staff members and 20 children, 1 cook and facility director 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. Community Care Licensing was notified that lead water testing conducted at the facility on 9/28/2022 exceeded allowable limit for lead. Samples testing over 5.5 ppb/ug L and above is considered an exceedance. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedances (ALE) and conduct an inspection. On 10/26/2022 LPA Laureano via email received the following documents from facility, LIC 9275, LIC 9276, Facility Sketch (water faucets/outlets identified), pictures of fixtures and test results. LPA Laureano took pictures of faucets/ outlets during today's inspection. The facility has been identified to have 5 water facet/outlet with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5pb, or greater. LPA Laureano confirmed with director the following outlet/faucets were identified as exceedance of lead and shall remain inoperable. Classroom 1- Cold Bubbler- “E” 6.21 Classroom 1- Sink- “F” 10.1 Classroom 2- Bubbler- “G” 7.95 Outside Classroom 2 Bubbler- “K” 16.9 Outside Classroom 3 Bubbler- “M” 11.9

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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: SALVATION ARMY BESSIE PREGERSON CHILDCARE, THE	FACILITY NUMBER: 197407687
	VISIT DATE: 11/03/2022

NARRATIVE

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LPA Laureano observed all outlets identified with an Action Level Exceedance to be made inaccisble to the children in care. LPA Interviewed director and staff to ensure children do not have access to the identified sinks/outlets that has been identified as exceedance of lead. Children have access to water via filter water pitcher in each classroom and water pitcher is available when children are outdoors. LPA observed a water dispenser in the lobby making water readily accessible to children in care.

Based on observation, interviews and sampling records it has been determined that there was a violation of Licensing Regulation Title Division 12, Chapter 1, Subchapter 5 – California Lead Action Level at Child Care Centers 101700.3(b)(1), “A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance”. Lead water testing samples taken on 9/28/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during today’s visit 11/3/2022. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. In Accordance with California Code of Regulations. Refer to LIC 809-D.

LPA discussed Proof of Correction (POC) with Director. All faucets identified with an Action Lead Exceedance of 5.5 ppb or over have been made inaccessible to the children in care. These outlets will not be accessible for use until a retest has occurred. A notification of letter will be drafted by facility to sent out to parents with notification of cease of water outlets and remediation for planned for water outlets or alternative. Director will send LPA a copy of the letter via email by 11/21/2022. Facility will work to begin repairs and will notified LPA when repairs are schedule and schedule a second test of identified outlets when repairs are completed no later than 12/30/2022.

Instructions for required lead testing are outlined in PIN 21-21. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations Care Child Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in a parts per billion (ppb) unit of measurement.
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

Director received Notice of Site Visit and copy of this report.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 11/22/2022 12:18 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: SALVATION ARMY BESSIE PREGERSON CHILDCARE, THE	FACILITY NUMBER: 197407687
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/03/2022 Section Cited	1 2 3 4 5 6 7	101700.3(b)(1), A result with values of 5.5 ppb or greater shall be deemed an ActionLevel Exceedance
	8 9 10 11 12 13 14	Based on observation,interviews, and review of lead water testing samples taken on 09/28/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California- 5 water outlets (E, F,G,K and M).This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	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: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC809 (FAS) - (06/04)

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