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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419606
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:19:07 PM


Document Has Been Signed on 02/14/2023 12:19 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:PACE - YOUNG INNOVATORFACILITY NUMBER:
197419606
ADMINISTRATOR:ARAKELYAN, ANUSHFACILITY TYPE:
850
ADDRESS:3740 DON FELIPE DRIVETELEPHONE:
(323) 389-8470
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:40CENSUS: 28DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH: Ruzanna DavtianTIME COMPLETED:
12:15 PM
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On 02/14/2023 Licensing Program Analyst (LPA) Doris Whitmore arrived at PACE Headstart Young Innovators to conduct an unannounced case management visit. LPA Whitmore was met by Ruzanna Davtian LPA Whitmore informed Regional Site Director about the purpose of the visit and was guided on a tour of the facility. There were 6 teachers and 28 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.

The Department was notified that the facility has been identified to have water outlets with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 parts per billion (pbb), or greater. The purpose of today’s visit is to ensure that water outlets are not in use and there is a potable source of water for children and staff at the facility.

During todays visit LPA Doris Whitmore conducted a tour of the facility and observed one outlet that was tagged and not in use. This outlet was identified on the facility sketch. Regional Site Director stated that the outlet that was tested was used only for art activities and used by the teacher. LPA observed a water disperser in the classrooms with jugs of water for the children to drink. Also children have drinking water outside as well.

On 12/30/2022 Licensing Program Analyst Doris Whitmore received the following documents: Correction Action Plan for lead Exceedance fixture inside classroom #2, facility sketch, Fixture A, External Water Sampler Self- Certification Form (LIC9275), Child Care Center Sampling Checklist Form ( LIC9276), Silver State Analytical Laboratories, test results, Chain of Custody Form,

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PACE - YOUNG INNOVATOR
FACILITY NUMBER: 197419606
VISIT DATE: 02/14/2023
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Lead Water sample testing conducted by Silverstate Analytical Laboratories. The facility prep was prep for water sampling on 10/14/2022, tested 10/24/2022 The lab collected the water sample on. 10/15/2022 The facility received the results on 12/ 15/ 22 Samples submitted to the Silverstate Analytical Laboratories on 12/15/2023. Per the report, the following water outlet yielded the following results:
1. Fixture A Classroom #2 Sink

Based on observation, interviews and supportive documents it has been determined that PACE Young Innovators 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 10/24/22 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 02/14/2023. 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 Regional Site Director Ruzanna Davtian. A Correction Action Plan was submitted that the Lead Exceedance was noted in a fixture inside classroom#2 sink. The fixture will be replaced with a no lead fixture specification by January 31, 2023. LPA Whitmore spoke with Sal Chavarian , Maintenance Supervisor & Amanda Velasquez , Assistant Director of Education. LPA Whitmore shared information that a new Correction Plan shall be submitted with the new date. According the Correction Action Plan The fixture has not been replaced by 01/31/2023. The new date will be Tuesday February 21. 2023. Maintenance Supervisor stated that the there is no shut off valve under the sink and the entire water will need to be shut off when there is no children in care.

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 Regional Site Director Ruzanna Davitanwas provided a copy of the report and appeal rights.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/14/2023 12:19 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: PACE - YOUNG INNOVATOR
FACILITY NUMBER: 197419606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2023
Section Cited

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California Lead Action Level at Child Care Centers. A result with values of 5.5ppb or greater shall be deemed an Action level Exceedance. This requirement is not met by evidence by lead water testing samples taken on 10/15/2022 reveled the levels of lead
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 Sal Chavarian Mainteance Supervisor & Amanda Velasquez will submit a new Plan of Correction with a new date that the sink in classroom #2 the fixture will be repplaced with a no lead fiixture. Also Parents will receive a letter informing them the level of lead in the classroom#2 sink. Sink will be retested.

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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 EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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