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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191604266
Report Date: 07/13/2023
Date Signed: 07/13/2023 03:25:55 PM

Document Has Been Signed on 07/13/2023 03:25 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:JOURNEY OF FAITHFACILITY NUMBER:
191604266
ADMINISTRATOR:NANCY KIMFACILITY TYPE:
850
ADDRESS:1243 ARTESIA BOULEVARDTELEPHONE:
(310) 374-0583
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 165TOTAL ENROLLED CHILDREN: 165CENSUS: 92DATE:
07/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nancy Kim, DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
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On 7/13/2023, Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced case management - lead testing/exceedance visit. LPA met with Director, Nancy Kim and toured the facility. LPA observed 92 children in care with 11 staff members.

LPA explained the purpose of the visit. The department has received testing results, indicating 2 water outlets have been identified with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5 ppb, or greater.

During today’s inspection, LPA obtained the following documents: Child Care Center Sampling Checklist Form (LIC 9276), External Water Sampler Self-Certification Form (LIC 9275), Facility Sketch labeled with locations of all water outlets that were tested, water results summary and plan of correction.

LPA observed water outlet D (room 102) and water outlet R (room E106) has ALE. Outlet D and R have been identified and labeled on the facility sketch. Both outlets in the classrooms 102 and E106 are drinking fountains. Director stated the facility stop using the fountains in 2020. LPA ensured the water outlets were not in use and there is a potable source of water for children and staff. Drinking water is available indoors and indoors from a Brita filter pitcher using filter water from the school kitchen. LPA observed Lead Testing results and plan of correction posted on Parent Board.

Lead water testing samples collected on 6/3/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California. Per the Written Directives for Lead Testing of Water in Licensed Child Care Center, AB 2370 the following deficiency is cited (See next page 809-D).

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JOURNEY OF FAITH
FACILITY NUMBER: 191604266
VISIT DATE: 07/13/2023
NARRATIVE
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For more information, go to the California Childhood. Lead Poisoning Prevention website at www.cdph.ca.gov/programs/clppb Please see Provider Information Notice (PIN) 20-01-CCP for more information about lead toxicity prevention

An Exit interview conducted and appeal right explained. A copy of this report, appeal rights, and Notice of Site Visit provided to Nancy Kim, Director.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2023 03:25 PM - It Cannot Be Edited


Created By: Loyce Phillips On 07/13/2023 at 02:32 PM
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: JOURNEY OF FAITH
FACILITY NUMBER: 191604266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2023
Section Cited

101700.3(b)(1)

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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 the Action Level Exceedance results revealed
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Director has sealed the water outlets. Outlets are not use for food or drinking consumption. Plan to remove the outlets completely by 8/01/2023. Director will send LPA a Plan of Correction regarding remediation of outlets on or before 8/10/2023.
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that levels of lead were beyond allowable amount deemed by the State of California and if not corrected this poses a potential Health and Safety or Personal Rights risk to children in care.
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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:Karren Starks
LICENSING EVALUATOR NAME:Loyce Phillips
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023


LIC809 (FAS) - (06/04)
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