191201842-5-19-2023-58-CC-AALA-CRYNNH-20230519103647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191201842
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:36:54 AM

Document Has Been Signed on 05/19/2023 10:36 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:	HIGHLAND HALL SCHOOL		FACILITY NUMBER:	191201842
ADMINISTRATOR:	FERRIS, LAURA		FACILITY TYPE:	850
ADDRESS:	17100 SUPERIOR STREET		TELEPHONE:	(818) 349-1394
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 106	TOTAL ENROLLED CHILDREN: 106	CENSUS: 26	DATE:	05/19/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:14 AM
MET WITH:	Cara Lisco, Director of Operations		TIME COMPLETED:	10:51 AM

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On 05/19/2023 at 8:45 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 Cara Lisco, Director of Operations and toured the facility. During today’s visit there are 26 children and 8 teachers.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 04/04/2023.

The sample test for the water faucet/fountain located in the Parent Child room, identified on the facility sketch by letter “F”, tested at 31 bbp. Test samples testing over 5.5 ppb and above is considered an exceedance.

During today’s visit LPA observed the water faucet/fountain located inside the Parent Child room covered with a plastic bag and “Do not use until removed by sampler” sign. The Director is reporting that the facility will place a water filter on the water outlet and have the water faucet/fountain retested.

Licensee has posted lead testing results, in a location (facility lobby) consistent with the requirements of written directives 101703, section 1596.8595, subsection (b) 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 “F”.

During today’s visit LPA took pictures of the water outlet “F”. 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.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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: HIGHLAND HALL SCHOOL	FACILITY NUMBER: 191201842
	VISIT DATE: 05/19/2023

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During today’s visit one Type B violation is being issued per PIN 21.1-21-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) 21.1-21CCP 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 Cara Lisco, Director of Operations.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/19/2023 10:36 AM - It Cannot Be Edited

Created By: Antonio Almanza On 05/19/2023 at 09:49 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HIGHLAND HALL SCHOOL	FACILITY NUMBER: 191201842
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/19/2023 Section Cited CCR 101700.3(b)(1)	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. This Requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility has covered the water faucet/fountain with a plastic bag and “Do not use until removed by sampler” sign.
	8 9 10 11 12 13 14	Based on observation, interview and record review, The water faucet/fountain identified on the facility sketch by letter “F”, tested at 31 bbp which is considered an exceedance, which poses a potential Health or Safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	The Director agrees to place a water filter on the water outlet and have the water faucet/fountain retested by 06/19/23.
	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

LICENSING EVALUATOR NAME:

Antonio Almanza

LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC809 (FAS) - (06/04)

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