197419442-3-21-2024-58-CC-LHEZ-D3KQVN-20240321123038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419442
Report Date: 03/21/2024
Date Signed: 03/21/2024 12:30:43 PM

Document Has Been Signed on 03/21/2024 12:30 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	COLISEUM ELEMENTARY SCHOOL CSPP		FACILITY NUMBER:	197419442
ADMINISTRATOR:	VALLES, SYLVIA		FACILITY TYPE:	850
ADDRESS:	4400 COLISEUM STREET RM. 25		TELEPHONE:	(323) 294-5244
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90016
CAPACITY:	24	CENSUS: 15	DATE:	03/21/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Susana Yorke - Washington, Principal		TIME COMPLETED:	12:40 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	Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 03/21/2024 for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPA arrived to the facility at 9:52AM and met with Susana Yorke - Washington, Principal, who guided analyst on a tour of the facility. LPA observed 15 children with 2 staff upon arrival. Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 11/8/2022. The sample test for the water fountain located outside Room 2, identified on the facility sketch by letter “A” , tested at 9.99 bbp and water fountain identified on the facility sketch by letter “B” , tested at 8.40 bbp exceed allowable limit for lead. Test samples testing over 5.5 ppb and above is considered an exceedance. During today’s visit LPA was provided with retesting results of the Lead Water Testing conducted at the facility on 1/26/2023. Principal provided LPA with a copy of the Plan of Corrections for both water outlet "A" and "B". The Principal is reporting that point -of use filters have been installed as a plan of correction. Principal did not have information relating to the maintenance of the point of use water filters. Principal contacted Scott Dwelley, Drinking Water Program Specialist, who via telephone verbally disclosed that point of use water filters will be maintained two times per year. Principal disclosed that a maintenance service log for the water filters will be kept at the facility. LPA took pictures of the water outlets “A” and “B”. 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 a copy of water testing results summary. ---Page 1 of 2

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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: COLISEUM ELEMENTARY SCHOOL CSPP	FACILITY NUMBER: 197419442
	VISIT DATE: 03/21/2024

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Principal was advised to posted lead testing results, in a location 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 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 outlet “A” and “B”.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Susana Yorke - Washington, Principal.

---Page 2 of 2

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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