197408524-2-7-2023-58-CC-DLOE-CNU3ZN-20230207174150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408524
Report Date: 02/07/2023
Date Signed: 02/07/2023 05:41:58 PM

Document Has Been Signed on 02/07/2023 05:41 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:	YMCA OF METRO LA/WEST VALLEY POMELO		FACILITY NUMBER:	197408524
ADMINISTRATOR:	MAITE FIERRO		FACILITY TYPE:	840
ADDRESS:	7633 MARCH AVENUE		TELEPHONE:	(818) 426-7151
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 39	CENSUS: 32	DATE:	02/07/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	02:06 PM
MET WITH:	Breanna MacDowall, Assistant Director		TIME COMPLETED:	03:09 PM

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On 02/07/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced case management visit. LPA Lowe was greeted by Assistant Director, Breanna MacDowall and granted entry into the facility. Assistant Director guided LPA Lowe on a tour of the facility. There were 32 children present under supervision of 3 staff 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 12/21/2022 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 lead testing results of Action Level Exceedances (ALE) and conduct an inspection.

During today’s visit LPA Lowe observed water facet/outlets identified on facility sketch. LPA Lowe reviewed the outlets list on the on the water testing documents and matched with facility sketch received. LPA observed outlet was covered with plastic.

LPA Lowe confirmed with Assistant Director that outlet “B” samples were identified as exceedance of lead and shall remain inoperable. LPA Lowe observed outlet “B” to be located in YMCA Child Care Room # 29. Facilities plan of correction is for outlet B to remain in operable and facility will provide drinking water with use of outlet located in YMCA Child Care Room #30.

LPA Lowe received at the El Segundo North Regional Office copies of LIC 9275, LIC 9276, Facility Sketch (water faucets/outlets identified) on 01/13/2023. LPA Lowe took pictures of faucets/ outlets during today’s visit.

Per Assistant Director facility provides disposable cups for children for water, children also bring water

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO LA/WEST VALLEY POMELO	FACILITY NUMBER: 197408524
	VISIT DATE: 02/07/2023

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bottles from home. LPA observed gallon size water from store being used to fill an Igloo water cooler that was observed to be available for children indoors and outdoors. Per assistant director, facility provides afternoon snacks. Facility does not have access to a kitchen. Snacks provided are dry snack or refrigerator needed snacks. Assistant Director stated snacks provided do not require the use of a water outlet.

Based on observation, interviews and sampling records it has been determined that there was a violation of Licensing Regulation Title 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 on 12/21/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Room 29 water fountain (sample B) lead exceedance level 5.67 ppb. This facility is being cited (1) deficiency during today’s visit 02/07/2023. This is 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.

LPA discussed Proof of Correction (POC) with Assistant Director. Facility has made faucet B identified with an Action Lead Exceedance of 5.5 ppb or over inaccessible to children in care. These outlets will not be accessible for use. LPA Lowe provided facility with signs to post stating Out of Service. A notification letter was sent out to parents with notification of cease of water outlets and remediation for planned for water outlets or alternative. YMCA provided LPA with letter/ notification to parents on 01/13/2023.

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were explained, and report was reviewed with the facility representative Maite Fierro Breanna MacDowall.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/07/2023 05:41 PM - It Cannot Be Edited

Created By: Deborah Lowe On 02/07/2023 at 03:07 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: YMCA OF METRO LA/WEST VALLEY POMELO	FACILITY NUMBER: 197408524
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/07/2023 Section Cited CCR 101700.3(b)(1)	1 2 3 4 5 6 7	101700.3(b)(1), A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Faucets have been placed inoperable. YMCA sumbitted a plan of correction to LPA Lowe on 01/13/2023. Water outlets in room 30 will be available to children in care in addition to gallon water bottles purchaeed from store.
	8 9 10 11 12 13 14	Based on observation, interviews, and review of Lead water testing samples taken on 12/21/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California. Room 29 water fountain had a lead exceedance levels of sample "B" at 5.67 ppb. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	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:

Lisa Rios

LICENSING EVALUATOR NAME:

Deborah Lowe

LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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