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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670977
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:01:19 PM

Document Has Been Signed on 09/27/2022 12:01 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:CHILDRENS PLACE, THEFACILITY NUMBER:
191670977
ADMINISTRATOR:KAMILAH BELLFACILITY TYPE:
850
ADDRESS:235 HILL STREETTELEPHONE:
(310) 399-6405
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 16DATE:
09/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:KAMILAH HIGGINS, DIRECTOR TIME COMPLETED:
12:15 PM
NARRATIVE
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On 09/27/2022, Licensing Program Analyst (LPA) Lisa Clayton, conducted an unannounced case management - deficiencies visit. LPA was greeted by Director Kamilah Higgins. LPA Clayton toured the facility and observed 16 children being care for and supervised appropriately by 6 teachers.

LPA Clayton 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 Clayton 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, and a copy the Parents notification. Director Higgins stated the facility has notified all parents via email and posted the Lead Testing Results on the parent board.

LPA observed the 2 water outlets that has ALE. Both outlets are located in the Children’s bathroom and are used exclusively for hand washing only. Teacher Jocelyn stated that the children do not drink from water outlets. LPA Clayton observed the outlets were bagged and were labeled with signs that states "Teachers/Staff: DO NOT ALLOW THE CHILDREN TO USE THE FAUCETS IN THE CHILDREN'S RESTROOM – PLEASE HAVE THE CHILDREN WASH THEIR HANDS AT THE SINK IN THE BONGO’S CLASSROOM – NOTICE THIS IS NOT A HAND WASHING SINK”. (See LIC812 – BATHROOM SINK PHOTOS).

see LIC 809-C

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHILDRENS PLACE, THE
FACILITY NUMBER: 191670977
VISIT DATE: 09/27/2022
NARRATIVE
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Lead water testing samples collected on 07/15/2022 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).

For more information, go to the California Childhood. Lead Poisoning Prevention Branch's 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 Kamilah Higgins.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/27/2022 12:01 PM - It Cannot Be Edited


Created By: Lisa Clayton On 09/27/2022 at 11:32 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: CHILDRENS PLACE, THE
FACILITY NUMBER: 191670977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
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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The Director and staff will ensure that the faucets in the children’s bathroom are used solely for the intended purpose of handwashing only.
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that levels of lead were beyond allowable amount deemed by the State of California, if not corrected this poses a potential Health and Safety or Personal Rights risk to children in care.
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Director Kamilah will post signs to directing that food prep, drinking, filling of water bottles or cups is NOT ALLOWED at the above-mentioned sinks/faucets. Immediately upon posting, a picture of the signs will be forwarded to LPA Clayton.

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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:Mary Ruiz
LICENSING EVALUATOR NAME:Lisa Clayton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022


LIC809 (FAS) - (06/04)
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