191604061-2-26-2024-30-CC-SGAA-D2TUL7-20240226144015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191604061
Report Date: 02/26/2024
Date Signed: 02/26/2024 02:40:29 PM

Document Has Been Signed on 02/26/2024 02:40 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	HICKORY TREE PRESCHOOL		FACILITY NUMBER:	191604061
ADMINISTRATOR:	JENNIFER WALLA		FACILITY TYPE:	850
ADDRESS:	21720 MADRONA AVENUE		TELEPHONE:	(310) 533-4830
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY: 100	TOTAL ENROLLED CHILDREN: 100	CENSUS: 50	DATE:	02/26/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Jennifer Walla, Sandy Hallworth, Lisa Hung		TIME COMPLETED:	02:50 PM

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On 02/26/2024, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management visit. LPA Garcia was greeted by administrator, Sandy Hallworth and facility director, Jennifer Walla. Administrator guided LPA on a tour of the facility. At 11:00am, LPA met with Lisa Hung.

LPA observed a total of 50 children being supervised by 4 teachers and the Director. The teacher to child ratios are as follow: Rm 2 (Moonjumpers): 11 children to 1 staff, Rm 1 (Tiggers) : 11 children to 1 staff, Rm 3 (Pre-K A) 9 children to 1 staff, Rm 7 (Pre-K B) : 11 children to 1 staff, Rm 8 (Sunshine) : 8 children to 1 staff, Rm 4, 5, 6 are not being utilized at this time. LPA observed Rooms 9, 10, 11 which are used by the elementary school.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all CCCs located in buildings constructed before January 1, 2010, to test their drinking water for lead contamination between January 1, 2020, and January 1, 2023, and then every 5 years after the date of the first test. The CCC must also post the results by January 1, 2023, and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure. Lead testing is not currently a pre-licensing requirement for CCCs. The lead testing requirement does not apply to Family Child Care Homes (FCCHs).

Community Care Licensing was notified that lead water testing conducted at the facility on 12/23/2023 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 lead testing results of Action Level Exceedances (ALE) and conduct an inspection.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HICKORY TREE PRESCHOOL	FACILITY NUMBER: 191604061
	VISIT DATE: 02/26/2024

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During the inspection LPA Garcia received the following documents from facility, lead test result, LIC 9275, LIC 9276, Facility Sketch (water faucets/outlets identified). LPA Garcia took pictures of the faucet/outlet in room 9.

The facility has been identified to have 1 water faucet/outlet located in the Sample Site, “H” with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5pb, or greater. Facility Director confirmed the outlet/faucet, Sample Site "H" in room 9, identified as exceedance of lead shall be labeled and not used for consumption or food preparation. Room 9 is utilized by the elementary school.

LPA Garcia observed water outlet/faucet identified with an Action Level Exceedance to be labelled "Until completion of water testing this faucet is not to be used for drinking water or food preparation" and "This faucet is currently limited to non-portable water usage only." LPA took pictures of Sample Site "H" in Room 9. Director confirmed that children and staff do not use water for consumption or food preparation. LPA interviewed Director to ensure children do not utilize the identified faucet/outlet that has been identified as exceedance of lead for consumption and food preparation. Children have access to water faucets in the classroom and children bring in their own refillable water bottles. LPA observed a sink faucets in the classrooms; making water readily accessible to children in care. The sink faucets have been tested and cleared.

Based on observation, interview and sampling records it has been determined that there was a violation of Licensing Regulation Title 22, Division 12, Chapter 1, Subchapter 5 – California Lead Action Level at Child Care Centers 101700.3(b)(1), “A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.” Lead water testing samples taken 12/29/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. In Accordance with California Code of Regulations. Refer to LIC 809-D.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HICKORY TREE PRESCHOOL	FACILITY NUMBER: 191604061
	VISIT DATE: 02/26/2024

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LPA discussed Proof of Correction (POC) with Director. Faucet/water outlet “H”, identified with an Action Lead Exceedance of 5.5 ppb or over has been properly labelled for the children in care. Outlet The outlet will be labelled until a retest has occurred. Per the director, the faucet/outlet "H" was replaced on 01/11/2024. LPA instructed director that until a retest occurs with the results below 5.5 ppb the water shall not be used for consumption or food preparation. A notification of letter will be drafted by facility to be sent out to parents with notification of lead exceedance and restrictions on water faucet/outlet "H" to cease consumption and food preparation and remediation for planned for water outlets or alternative. LPA received a copy of the letter during the visit. Facility will work on scheduling for a second test of identified outlet. Director will email LPA a copy of the re-test summary once completed.

Instructions for required lead testing are outlined in PIN 21-21. This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations Care Child Centers are expected to use an Environmental Laboratory Accreditation Program (ELAP), for lead testing. Accreditation from the California Environmental Laboratory Accreditation Program, known as an ELAP laboratory, is equipped to measure the amount of lead in a parts per billion (ppb) unit of measurement.

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.

Notice of Site Visit and copy of this report along with appeal rights was provided to executive director, Lisa Hung.

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SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/26/2024 02:40 PM - It Cannot Be Edited

Created By: Sarah Garcia On 02/26/2024 at 11:30 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: HICKORY TREE PRESCHOOL	FACILITY NUMBER: 191604061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/11/2024 Section Cited 101700.3	1 2 3 4 5 6 7	101700.3(b)(1) California Lead Action at Child Care Centers (b)Testing results with fractional ppb readings....(1) A result of 5.5ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by	1 2 3 4 5 6 7	Director replaced the water faucet labelled sample site "H". Director labelled the faucet/outlet shall not be used for consumption or food preparation. Director will notify parents of the lead testing and will provide LPA notification by 5pm on 03/11/2024.
	8 9 10 11 12 13 14	Based on observation, interview and record review of Lead water testing samples taken on 12/23, revealed that levels of lead were beyond allowable amount deemed by the State of California. The room 9 Water outlet had a lead exceedance levels of sample "H" at 28ppb. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	A restest will been completed and once results are available, a copy will be sent out to LPA via email sarah.garcia@dss.ca.gov.
	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:

Maureen Neal

LICENSING EVALUATOR NAME:

Sarah Garcia

LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

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