197417299-1-10-2023-58-CC-AALA-CMXPBN-20230110101038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417299
Report Date: 01/10/2023
Date Signed: 01/10/2023 10:11:06 AM

Document Has Been Signed on 01/10/2023 10:11 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:	UCLA WESTWOOD CHILD CARE CENTER		FACILITY NUMBER:	197417299
ADMINISTRATOR:	NICOLE FIORELLA		FACILITY TYPE:	830
ADDRESS:	10861 WEYBURN AVENUE #301		TELEPHONE:	(310) 481-0664
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	63	CENSUS: 49	DATE:	01/10/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Esther Miranda, Health & Safety Director		TIME COMPLETED:	10:15 AM

NARRATIVE

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On 01/10/2023 at 8:48 AM, Antonio Almanza, Licensing Program Analyst (LPA), conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Esther Miranda, Health & Safety Director, and toured the facility.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 11/11/2022. The sample test for the water fountain, located in Room U-3, identified on the facility sketch by letter “CC”, tested at 7.5 bbp/ug L, which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

LPA observed the water fountain inoperable; the faucet is covered with plastic bag and sign,” Do not use this Sink at all.” The Director is reporting that the classroom is not in use. The facility will have the water faucet capped off and removed from service. Facility will provide water ti children from the kitchen water filtration system.

Licensee has posted testing results, in a location (facility lobby) consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility within 24 hours of receiving the results from the Department. Facility has notified all parents or guardians of children in care of Lead Exceedance results and what has been done to date and remediation plan for water outlet “CC”.

During today’s visit LPA took pictures of the water faucet (CC). LPA received copies of External Water Sampler Self-Certification Form (LIC 9275); 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 summary was provided during the visit.

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.

SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

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: UCLA WESTWOOD CHILD CARE CENTER	FACILITY NUMBER: 197417299
	VISIT DATE: 01/10/2023

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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 emailed and provided 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 daysduring 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 Esther Miranda, Health & Safety Director.

SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/10/2023 10:11 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: UCLA WESTWOOD CHILD CARE CENTER	FACILITY NUMBER: 197417299
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/23/2023 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 have the water faucet capped off and removed from service. Facility will provide water to children from the kitchen water filtration system.
	8 9 10 11 12 13 14	Based on observation, interview and record review, Water faucet "CC" tested at 7.5 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
	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: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

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