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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191604221
Report Date: 10/28/2022
Date Signed: 10/28/2022 12:23:32 PM

Document Has Been Signed on 10/28/2022 12:23 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:BERKELEY HALL SCHOOL FOUNDATIONFACILITY NUMBER:
191604221
ADMINISTRATOR:NEWCOMB, BARBARAFACILITY TYPE:
850
ADDRESS:16000 MULHOLLAND DRTELEPHONE:
(310) 476-6421
CITY:LOS ANGELESSTATE: CAZIP CODE:
90049
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
10/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Jamie PatrickTIME COMPLETED:
12:38 PM
NARRATIVE
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On 10/28/2022 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management visit regarding Berkely Hall School Foundation. Jamie Patrick (Director) guided LPA Thompson on a tour of the facility. LPA observed 6 staff members and 27 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 lead water testing conducted at the facility on 09/28/2022 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.

During today’s visit LPA Thompson observed water facet/outlets identified on facility sketch within the State licensed facility. LPA Thompson confirmed with director that Faucets/Outlets A, AA and AB samples were identified as exceedance of lead. During further investigation it was determined that outlets AA and AB were located in Building F which is not within the facility licensed for preschool. LPA observed outlet A that is within the licensed preschool facility sketch building E.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: BERKELEY HALL SCHOOL FOUNDATION
FACILITY NUMBER: 191604221
VISIT DATE: 10/28/2022
NARRATIVE
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This water faucet/outlet was observed to be inoperable, covered with a label not in use and shut off. Per director, facility ceased the use of facet/outlet A. LPA took a picture of faucet/outlet A and water faucet/outlet B&C as an alternate for usage.

Based on observation, interviews and sampling records it has been determined that there was a violation of Licensing Regulation please see Facility evaluation Report LIC 809D.

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

An Exit interview was conducted, this report was reviewed with Jamie Patrick (Director). The director was provided a copy of the report and appeal rights.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2022 12:23 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 10/28/2022 at 11:49 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: BERKELEY HALL SCHOOL FOUNDATION
FACILITY NUMBER: 191604221

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers(b) Testing results with fractional ppb readings of 0.5 ppb or greater....(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. The requirement was not met as evidence by:
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LPA discussed Proof of Correction (POC) with Director. Director agreed to cease the use of outlet/faucet A. This outlets will not be accessible for use. Notification of letter will be sent out to parents with notification of cease of water outlets and remediation planned for water outlets or alternative. Director will send LPA a copy of the letter via email by 11/4/2022.
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Lead water testing samples taken on 09/28/2022 revealed that levels of lead were beyond the allowable amount deemed by the State of California. Water Outlet “A” has Action Lead Exceedance (ALE) level 5.51 pbb.
This poses a potential health and safety risk to children in care.
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Director will follow up with California Rural Water Association. Director will get guidance and next appropriate and final step. Director will provide LPA with guidance and corrections by 11/4/2022

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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:Lisa Rios
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022


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