197494267-10-27-2022-58-CC-AALA-CKLR9S-20221027125000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494267
Report Date: 10/27/2022
Date Signed: 10/27/2022 12:50:44 PM

Document Has Been Signed on 10/27/2022 12:50 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:	SANTA MONICA-MALIBU USD/WEBSTER SEASIDE PRESCHOOL		FACILITY NUMBER:	197494267
ADMINISTRATOR:	DR SUSAN SAMARGE-POWELL		FACILITY TYPE:	850
ADDRESS:	3602 WINTER CANYON		TELEPHONE:	(310) 456-6494
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY:	24	CENSUS: 10	DATE:	10/27/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Director DR SUSAN SAMARGE-POWELL		TIME COMPLETED:	01:00 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 10/27/2022 at 9:21 AM, Licensing Program Analyst (LPA) Antonio Almanza conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. Facility Director DR SUSAN SAMARGE-POWELL arrived to the facility at approximately 10:20 AM and guided LPA on a tour of the facility. During today’s visit there are 10 children and 3 teachers. Risk Assessment was conducted prior to conducting site visit.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 09/09/2022. There are three water outlets (C, D, and H) that exceed allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

The sample test for water faucets (C) and water fountain (D), located in the Teacher Work-Room, inside of Preschool Classroom #11. Water Faucet identified on the facility sketch by letter (C) tested at 120 ppb/ug L. Water fountain identified on the facility sketch by letter (D), tested at 25 ppb/ug L.

Water Faucet identified on the facility sketch by letter (H/A), tested at 16 ppb/ug L. This faucet is not located at the Licensed Child Care Center. This Faucet is located at Malibu High School kitchen which is located at a different location than the Child Care Center. Water outlet at the High School was tested under the Licensed Child Care Center because they provide meals for the preschool.

Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

During today’s visit LPA observed water outlets (C), and (D). LPA observed the outlets inaccessible and turned off; the outlets are covered in plastic black bags and have “Out of Service” sign.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA MONICA-MALIBU USD/WEBSTER SEASIDE PRESCHOOL	FACILITY NUMBER: 197494267
	VISIT DATE: 10/27/2022

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 Director is reporting that water outlet (C) and (D) were not used by children in care and the Teacher Work room where they are located is inaccessible to children in care. The facility will have water outlets removed and replaced and Facility Director will provide LPA with an update of when this will take place by 11/01/22.

Facility has posted testing results in preschool classroom, 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. On 09/27/22, Facility notify all parents or guardians of children in care of Lead Exceedance results and what had been done to date and remediation plan for water outlet with Lead Exceedance.

During today’s visit LPA took pictures of the water faucet (C), and water fountain (D). LPA received an email from the facility with copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276); and copy of water testing results summary was provided during the visit. Updated Facility Sketch (LIC 999) will be emailed to LPA in which all water outlets noted.

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.

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 days during 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 the Director DR SUSAN SAMARGE-POWELL.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 10/27/2022 12:50 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA MONICA-MALIBU USD/WEBSTER SEASIDE PRESCHOOL	FACILITY NUMBER: 197494267
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/01/2022 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:
	8 9 10 11 12 13 14	Based on observation, interview and record review, The facility had faucet (C) and (D) test with Lead Exceedance, 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

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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3