191202129-12-8-2022-58-CC-SORS-CLWQP7-20221208112016

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202129
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:20:28 AM

Document Has Been Signed on 12/08/2022 11:20 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:	TEMPLE ALIYAH		FACILITY NUMBER:	191202129
ADMINISTRATOR:	ANDREA SEGALL		FACILITY TYPE:	850
ADDRESS:	6025 VALLEY CIRCLE BLVD.		TELEPHONE:	(818) 346-1552
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	218	CENSUS: 45	DATE:	12/08/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Robin Wayne Director and Jennifer Pearlman Associate Director		TIME COMPLETED:	11:45 AM

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 12/08/2022 Licensing Program Analyst (LPA) Suzette Ornelas conducted an announced case management visit. LPA was greeted by Robin Wayne, Director and Jennifer Pearlman Associate Director who granted entry into the facility and guided LPA on a tour. LPA observed 23 teachers and 45 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. Community Care Licensing was notified that the initial lead water testing was conducted at the facility on 08/18/2022 exceeded allowable limit for lead. Samples testing over 5.5 ppb/ug L and above is considered an exceedance. The Purpose of today’s visit is to follow up on the lead testing results of Action Level Exceedances (ALE) and conduct an inspection. On 10/2022 Executive Director Aliza Goland contacted Department of Water and Power (DWP) to obtain a second opinion. DWP conducted a visit and retested a few of the contaminated faucets which showed ALE. DWP confirmed the ALE and informed facility representative that they would have to re-pipe the entire facility and that the source water was not contaminated. On 11/10/2022, Cullligan Plumbing Company installed reverse osmosis system in all 14 classrooms. As of today, facility has not had the outlets retested; however, there has been a Fixture Replacement Form (AB2370) Submitted to waterboards.ca.gov. During today’s visit LPA observed water facet/outlets identified on facility sketch and took pictures. LPA confirmed with director that outlets A, B, C, D, E, F, G, H, I, J, O, P, Q, R in Rooms 1-14, samples were identified as having an exceedance of lead and shall remain inoperable. LPA observed outlet locations. All 14 faucets were observed to be inoperable, covered, shut off.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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: TEMPLE ALIYAH	FACILITY NUMBER: 191202129
	VISIT DATE: 12/08/2022

NARRATIVE

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The children and staff do not have access to outlet/fountain. Per director, facility ceased the use of faucet/outlet. LPA observed faucet/outlet labeled not in use and taped off along with a disposable water dispenser located next to sink.

LPA provided facility representative with Instructions for required lead testing outlined in PIN 21-21 CCP and Lead Testing Question and Answers. This PIN contains Written Directives, which have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.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. LPA provided technical assistance and discussed wavier for drinking water as outlined in PIN 21-21-CCP.

Based on observation, interviews and supportive documents it has been determined that the facility violated Child Care Licensing Regulation Division 12, Chapter 1, 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. Lead water testing samples taken on 08/18/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California.

This facility is being cited (1) deficiency during today’s visit. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page.

LPA discussed Proof of Correction (POC) with Director demonstrated that all required actions were taken to correct the violation once discovered. Director will update CCL with any updates as needed.

A notice of site visit (LIC 9213) was given and must remain posted for 30 days.

An Exit interview was conducted, report was reviewed with the Director Jackie Schiulz. Licensee was provided a copy of the report and appeal rights.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 12/08/2022 11:20 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: TEMPLE ALIYAH	FACILITY NUMBER: 191202129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/08/2022 Section Cited	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: Lead water testing samples taken on 08/18/2022 revealed that levels of lead
	8 9 10 11 12 13 14	were beyond the allowable amount deemed by the State of California. This is a type B violation which poses a potential Health, 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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

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