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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410448
Report Date: 05/03/2023
Date Signed: 05/03/2023 03:16:39 PM

Document Has Been Signed on 05/03/2023 03:16 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:UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.FACILITY NUMBER:
197410448
ADMINISTRATOR:MARIA PATRICE WINNFACILITY TYPE:
830
ADDRESS:320 NO. CHARLES E. YOUNG DR.TELEPHONE:
(310) 206-0633
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY: 20TOTAL ENROLLED CHILDREN: 25CENSUS: 18DATE:
05/03/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Lead Teacher/Assistant DIrector - Courtney Kumar and Maria PAtrice Wynn- DirectorTIME COMPLETED:
03:35 PM
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On 05/03/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG. to conduct an unannounced case management visit. LPA Ornelas was met by Assistant Director - Courtney Kumar and Maria Patrice Wynn- Director (who arrived after the facility tour). LPA informed Assistant Director about the purpose of the visit and was guided on a tour of the facility. LPA observed 18 children and 9 adults during today’s visit.

The facility has been identified to have a water outlet with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 ppb, or greater. The purpose of today’s visit is to ensure that faucets are not in use and there is potable source of water for children and staff at the facility.

Per retest information provided by Licensing Program Manager (LPM) that was conducted on 2/14/2023, the following water outlet yielded the following results:

1) Faucet C- 6.0 ppb
Per Director and documentation, Faucet C ( located in the Gold Room Yard) did not test for lead exceedance on 10/31/2022, which was the first time samples were collected. Therefore, it was not retested on 2/14/2023.

During the facility visit on 4/10/2023, there was a misunderstanding. It has now been clarified that
Faucet G - Outdoor Blue Yard - Spigot Next to Blue Room entrance): 6.0 ppb

During today’s visit LPA Ornelas conducted a tour of the facility and observed 1 water outlet spigot (Faucet G) that has been made inaccessible. Not used for food prep or consumption. LPA obtained photo of the water outlet that was identified on the facility sketch. Director stated that the children do not consume water from the water outlet. Per assistant director, purified Brita filtered drinking water is provided and accessible to children in care. LPA observed Brita filtered water in the classrooms.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG.
FACILITY NUMBER: 197410448
VISIT DATE: 05/03/2023
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Based on observation, interviews and supportive documents it has been determined that UCLA DEPT. OF PSYCHOLOGY FERNALD INFANT DEV.PROG violated Child Care Licensing Regulation Division 12, Chapter 1, Subchapter 5 101700.3 (b)(1) 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.

Lead water testing sample re taken on 02/14/2023 revealed that levels of lead were beyond allowable amount deemed by the State of California for Faucet G.

At this time, LPA did not observe and was unable to obtain test results that show Faucet C tested for Lead Exceedance.

LPA obtained: External Water Sample Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), and Facility Sketch (fully labeled with locations of all water outlets), Final Results Report for 10/31/2022 and 02/28/2023.

LPA discussed Proof of Correction (POC). Director stated Faucet G will be capped off and be taken out of use on or before 6/3/2023. LPA will be notified via email at suzette.ornelas@dss.ca.gov

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 conducted. A copy of this report, and Notice of Site Visit provided to Director.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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