197414609-10-12-2022-30-CC-DWHE-CK5RWQ-20221012132331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414609
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:23:38 PM

Document Has Been Signed on 10/12/2022 01:23 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:	JOHN ADAMS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	197414609
ADMINISTRATOR:	SUSAN SAMARGE		FACILITY TYPE:	850
ADDRESS:	2320 17TH STREET		TELEPHONE:	(310) 399-5865
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	65	CENSUS: 25	DATE:	10/12/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Reham Dabash		TIME COMPLETED:	01:30 PM

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 10/12/2022 Licensing Program Analyst (LPA) Doris Whitmore arrived at John Adams Child Development Center to conduct an unannounced case management visit. LPA Whitmore was met by Assistant Director Reham Dabash. LPA Whitmore informed Assistant Director about the purpose of the visit and was guided on a tour of the facility. There were 5 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.

On 09/26/2022 LPA Whitmore via email received the following documents from facility facility sketch,pictures of fixtures, test results, letter to the Parents including plan of correction,& lab receipt.

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. The water fixtures that were tested were used for only handwashing and not drinking water. Facility still tested handwashing fixtures LPA observed in two of the classrooms ArrowHead water dispenser machine.

Testing was conducted on 09/01/2022 and samples were received by the laboratory Clincical Laboratory of San Bernadino, Inc. Per the report, the following water outlets yielded the following results:

1. Fixture A (C1 sink right)

2. Fixture B (C1 Sink left)

3. Fixture D (CC2 sink right)

4. Fixture E (CC3 sink left)

5. Fixture E (CC2 sink left)

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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 3

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: JOHN ADAMS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197414609
	VISIT DATE: 10/12/2022

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
26
27
28
29
30
31
32

The facility was prep for water sampling on 08/29/2022 the water was sampled and sent to the lab on 08/30/2022 and tested 09/01/2022., Facility received the results on 09/16/2022, notification was posted 09/20/22, and letter to parents was emaileed and given a hard copy on 09/22/2022

During today’s Learning sit LPA obtained the Water Quality Assessment AB2370 Lead Sampling documents from Director of Early Susan Samarge- Powell. LPA will upload the documents to the CA State Water Resources Control Board, Division of Drinking Water (DDW) database. During today’s visit LPA Whitmore conducted the tour of the facility and observed 4 sinks. LPA Whitmore took pictures of the fixtures in the classrooms.

Based on observation, interviews and supportive documents it has been determined that John Adams Child Development Center 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 08/30/2022 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 10/12/2022. 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 Director Susan Samarge- Powell & Assistant Director Reham Dabash.

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 Director Reham Dabash 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: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 10/12/2022 01:23 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: JOHN ADAMS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197414609
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/12/2022 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 Exceedance.
	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: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3