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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415787
Report Date: 05/15/2024
Date Signed: 05/15/2024 01:24:23 PM

Document Has Been Signed on 05/15/2024 01:24 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:GARDNER ELEMENTARY SCHOOLFACILITY NUMBER:
197415787
ADMINISTRATOR/
DIRECTOR:		URBINA, KENNETHFACILITY TYPE:
850
ADDRESS:7450 HAWTHORNE AVENUE ROOM #15TELEPHONE:
(323) 876-4710
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 11DATE:
05/15/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:49 AM
MET WITH:Rebecca Cabrera, Principal TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 05/15/2024 for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPAs arrived to the facility at 11:49AM and met with Rebecca Cabrera, Principal, who instructed Mario Cortes, Plant Manager to guide analysts on a tour of the facility. LPA observed 11 children in care and 2 staff present upon arrival.

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 of the results of the Lead Water Testing conducted at the facility on 11/29/2022. The sample test was for the water fountain located inside Room 15 Room 3, identified on the facility sketch by letter “A”, and water fountain outlet outside of Room 15 identified on the facility sketch by letter “B”. Outlet "B" tested at 1920 ppb which exceeds allowable limits for lead. Test samples testing over 5.5 ppb and above is considered an exceedance.

Principal was advised to posted lead testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility within 24-hours of receiving the results from the Department. Facility will notify all parents or guardians of children in care of lead exceedance results and what has been done to date and remediation plan for water outlet “B”.

During today’s visit LPA took pictures of the water outlets “A” and "B. LPA received copies of Facility Sketch (LIC 999) in which all water outlets are noted, water testing results dates 12/05/2022, External Water Sampler Self-Certification Form (LIC 9275), and Child Care Center Sampling Checklist Form (LIC 9276). ---Page 1 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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: GARDNER ELEMENTARY SCHOOL
FACILITY NUMBER: 197415787
VISIT DATE: 05/15/2024
NARRATIVE
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LPA also received a copy of the water retesting results summary for Outlet "B" that reports Outlet"B" is no longer in exceedance. A Statement of Deficiencies/Plan of Correction was not provided. Per Plant Manager, a point of use filter was installed for Outlet "B" on 07/07/2023.(photo taken)

Based on interviews and supportive documents it has been determined that GARDNER ELEMENTARY SCHOOL 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. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care. Refer to LIC 809-D for deficiency page.

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

Exit interview conducted and report was reviewed with Rebecca Cabrera, Principal.

---Page 2 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2024 01:24 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 05/15/2024 at 12:47 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: GARDNER ELEMENTARY SCHOOL
FACILITY NUMBER: 197415787

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2024
Section Cited
CCR
101700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Mario Cortes, Plant Manager submitted updates for corrections to Outlet "B", water retesting results via email to the Department on 5/15/2024. LPA observed a filtered that was installed on 07/07/2023 for Outlet "B" as part of the correction.
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This requirement was not met as evidence by: Based on interview and supportive documents, the facility did not comply with the section cited above in the water outlet located outside Room 15, identified on the facility sketch by letter “B”, tested at 1920 ppb on 11/29/2022 exceeding allowable limit for lead which poses a potential Health, Safety or Personal Rights risk to persons in care.
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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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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