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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607582
Report Date: 10/12/2022
Date Signed: 10/12/2022 02:45:19 PM

Document Has Been Signed on 10/12/2022 02:45 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SANTA MONICA-MALIBU USD/ROGERS H.S./S.P.FACILITY NUMBER:
191607582
ADMINISTRATOR:ALICE CHUNGFACILITY TYPE:
850
ADDRESS:2401 14TH STREETTELEPHONE:
(310) 399-6950
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 8DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Reham DabashTIME COMPLETED:
03:00 PM
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On 10/12/2022 Licensing Program Analyst (LPA) Doris Whitmore arrived at Will Rogers Pre-school to conduct an unannounced case management visit. LPA Whitmore was met by Assistant Director Reham Dabash. LPA Whitmore informed Assistant Director about the purpose of the visit and was guided on a tour of the facility. There were 2 teachers and 8 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.

On 09/26/2022 LPA Whitmore via email received the following documents from facility facility sketch,pictures of fixtures, test results, letter to the Parents including plan of correction,& lab receipt.

The facility has been identified to have 1 water facet/outlet with an Action Level Exceedance (ALE) in the amount of lead in water being 5.5pb, or greater. The water fixtures that were tested were used for only handwashing and not drinking water. Facility still tested handwashing fixtures. LPA observed one water bubbler attached to the classroom. Currently the outlet is removed from service.

Testing was conducted on 09/01/2022 and samples were received by the laboratory Clincical Laboratory of San Bernadino, Inc. Per the report, the following water outlets yielded the following results:

1. Fixture A (B3) sink right) 6.6

The facility was prep for water sampling on 08/29/2022 the water was sampled and sent to the lab on 08/30/2022 and tested 09/01/2022., Facility received the results on 09/16/2022, notification was posted 09/20/22, and letter to parents was emaileed and given a hard copy on 09/22/2022

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA MONICA-MALIBU USD/ROGERS H.S./S.P.
FACILITY NUMBER: 191607582
VISIT DATE: 10/12/2022
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During today’s Learning sit LPA obtained the Water Quality Assessment AB2370 Lead Sampling documents from Director of Early Susan Samarge- Powell. LPA will upload the documents to the CA State Water Resources Control Board, Division of Drinking Water (DDW) database. During today’s visit LPA Whitmore conducted the tour of the facility and observed 1 sink. LPA Whitmore took pictures of the fixtures in the classrooms.

Based on observation, interviews and supportive documents it has been determined that Will Rogers Preschool violated Child Care Licensing Regulation Division 12 Chapter 1, Subchapter 5 1017003 (b) (1) California Lead Action Level at Child Care Centers. A result with values of 5.5ppb or greater shall be deemed an Action Level Exceedance. Lead water testing samples taken on 08/30/2022 reveled that levels of lead were beyond allowable amount deemed by the State of California. This facility is being cited (1) deficiency during todays visit 10/12/2022. This is a type B violation which poses a potential Health, Safety, or Personal Rights risk to persons in care. Refer to LIC809-D for deficiency page.

LPA discussed Proof of Correction (POC) with Director Susan Samarge- Powell & Assistant Director Reham Dabash.

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.

Exit interview was conducted, report was reviewed with Director Reham Dabash licensee was provided a copy of the report and appeal rights.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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Document Has Been Signed on 10/12/2022 02:45 PM - It Cannot Be Edited


Created By: Doris Whitmore On 10/12/2022 at 02:38 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: SANTA MONICA-MALIBU USD/ROGERS H.S./S.P.
FACILITY NUMBER: 191607582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2022
Section Cited
CCR
101700.3(b)(1)

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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.
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Director Susan Samage- Powell stated that none of the outlets were used for fppd preparation or drinking, notification provided alternative drinking water source provide replacement of fixtures, fixture conditioning, follow up testing

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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Doris Whitmore
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022


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