197415364-2-1-2023-30-CC-LPHS-CNMT46-20230201132326

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415364
Report Date: 02/01/2023
Date Signed: 02/01/2023 01:23:35 PM

Document Has Been Signed on 02/01/2023 01:23 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:	SOUTH BAY UNIVERSAL CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	197415364
ADMINISTRATOR:	SUSAN TALEBIAN		FACILITY TYPE:	850
ADDRESS:	14025 CORDARY AVENUE		TELEPHONE:	(310) 970-0435
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 22	DATE:	02/01/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	SUSAN TALEBIAN, DIRECTOR		TIME COMPLETED:	01:40 PM

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On 2/1/2023, Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced case management - deficiencies visit. LPA was met by Director, LPA toured the facility and observed 22 children in care.

LPA explained the purpose of the visit. The department has received testing results, indicating 3 water outlet 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 and water results summary.

In classroom #1, LPA observed water outlet B has ALE. Outlet B was identified and labeled on the facility sketch. Director, informed LPA the Water Sampler tested outlet B twice (B30) and recorded the results. In classroom #2, LPA observed water outlet E has ALE. Outlet E was identified and labeled on the facility sketch. Both outlets in the classrooms #1 and #2 are water fountains. Director stated the outlet have been inoperable for before Pandemic. 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 outdoors. The facility use Sparkletts Water delivery service. LPA observed a top loading 5 gallon water dispenser with 3 additional 5 gallon water bottles. Director informed LPA of water delivery days. LPA observed Lead Testing results posted on Parent Board.

Lead water testing samples collected on 12/20/2022 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).809-C

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SOUTH BAY UNIVERSAL CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197415364
	VISIT DATE: 02/01/2023

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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 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 Director, Susan Talebian

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/01/2023 01:23 PM - It Cannot Be Edited

Created By: Loyce Phillips On 02/01/2023 at 12:42 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: SOUTH BAY UNIVERSAL CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197415364
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 02/10/2023 Section Cited 101700.3(b)(1)	1 2 3 4 5 6 7	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	1 2 3 4 5 6 7	Director has covered the water outlets identified with an Action Lead Exceedance of 5.5 ppb or over. Director will send LPA a Plan of Correction regarding remediation of outlets on or before 2/10/2023.
	8 9 10 11 12 13 14	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.	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:

Peter Flores

LICENSING EVALUATOR NAME:

Loyce Phillips

LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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