197418297-10-4-2022-58-CC-SMAZ-CJVTUN-20221004150236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418297
Report Date: 10/04/2022
Date Signed: 10/04/2022 03:02:48 PM

Document Has Been Signed on 10/04/2022 03:02 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:	BEL AIR PRESBYTERIAN CHURCH PRESCHOOL		FACILITY NUMBER:	197418297
ADMINISTRATOR:	JILLIAN MARSH		FACILITY TYPE:	850
ADDRESS:	16221 MULHOLLAND DRIVE		TELEPHONE:	(818) 990-6071
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90049
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 96	CENSUS: 70	DATE:	10/04/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Director Jillian Marsh Kim		TIME COMPLETED:	03:00 PM

NARRATIVE

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On 10/04/2022, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Bel Air Presbyterian Church Preschool to conduct an unannounced case management visit. LPA Martinez was met by Director Jillian Marsh Kim. LPA Martinez informed Director about the purpose of the visit and was guided on a tour of the facility.

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.

The Department was notified that the facility has been identified to have 4 water outlets with an Action Level Exceedance (ALE) in the amount of lead in the water being 5.5 parts per billion (pbb), or greater. The purpose of today’s visit is to ensure that water outlets are not in use and there is a potable source of water for children and staff at the facility.

On 09/27/2022, LPA Martinez contacted Director Jillian Marsh Kim and informed Director of the testing results. LPA also provided Director with the Written Directives in PIN 21-21 CCP for Lead Water Testing. Director provided LPA with a copy of the results of lead water sample testing conducted by Envirocheck, Inc. Testing was conducted on 06/23/2022 and results were received on 07/26/2022. Per the report, the following water outlets yielded the following results:

1.) Water Outlet “C” (Drinking fountain in Room 4): 20.9 pbb

2.) Water Outlet “I” (Drinking fountain in Hallway): 7.58 pbb

3.) Water Outlet “A” (Drinking fountain in Room 4): 7.39 pbb

4.) Water Outlet “H” (Drinking fountain in Room 2): 7.06 pbb

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Sabrina Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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

FACILITY NAME: BEL AIR PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 197418297
	VISIT DATE: 10/04/2022

NARRATIVE

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During today’s visit LPA Martinez conducted a tour of the facility and observed water outlets identified on facility sketch. LPA observed the 4 water outlets were bagged, taped, and labeled with the “Out of Service” signage. Director verified that children and staff do not have access to the water outlets that have been identified showing elevated lead levels. The drinking outlets have been replaced however is still not in use. Testing will be done again, and forms have been submitted to the Certified External Water Sampler. Director stated that other drinking fountains are available for children to use. Children bring their own snacks and lunches from home. Water outlets used for food preparation were not observed to have an Action Lead Exceedance (ALE) of 5.5 ppb or over.

During today’s inspection, LPA Martinez obtained the following documents: External Water Sampler Self-Certification Form (LIC 9275), Signed and dated Child Care Center Sampling Checklist Form (LIC 9276), Facility Sketch (fully labeled with locations of all water outlets), and photos of water outlets. LPA will upload the documents to the CA State Water Resources Control Board, Division of Drinking Water Database (DDW) database.

Based on observation, interviews, and supportive documents it has been determined that the facility has 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 samples taken on 06/23/2022 revealed that levels of lead were beyond the allowable amount deemed by the State of California. Water Outlets “C”, “I”, “A”, and “H” have Action Lead Exceedance (ALE) level of 20.9, 7.58, 7.39, 7.06 pbb.

This facility is being cited (1) deficiency during today’s visit 10/04/2022. 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.

LPA discussed Proof of Correction (POC) with Director. Director stated that the 4 water outlets identified with an Action Lead Exceedance of 5.5 ppb or over have been inoperable while the campus goes through the process of retesting the water outlets. These outlets will not be accessible for use until a retest has occurred. LPA Martinez observed signs posted stating Out of Service. A notification of letter was sent out to parents with notification of cease of water outlets and remediation for planned for water outlets or alternative. Director will send LPA a copy of the re-test summary once completed on or before 11/04/2022.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Sabrina Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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: BEL AIR PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 197418297
	VISIT DATE: 10/04/2022

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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 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 Director Jillian Marsh Kim.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Sabrina Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/04/2022 03:02 PM - It Cannot Be Edited

Created By: Sabrina Martinez On 10/04/2022 at 12:11 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: BEL AIR PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 197418297
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/04/2022 Section Cited CCR 101700.3(b)(1)	1 2 3 4 5 6 7	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 requirement is not met as evidenced by: Lead water testing samples taken on 06/23/2022 revealed that levels of lead were beyond the allowable amount deemed	1 2 3 4 5 6 7	Faciilty will either re-test or remove water outlets identified with an Action Lead Exceedance of 5.5 ppb or over. These outlets will not be accessible for use until a retest has occurred. Director will send LPA a copy of the results of the re-test summary or copy of the work order once completed. Deadline for POC is 11/04/2022.
	8 9 10 11 12 13 14	by the State of California. Water Outlets “C”, “I”, “A”, and “H” have Action Lead Exceedance (ALE) level of 20.9, 7.58, 7.39, 7.06 pbb. This is a potential risk to the health and safety of 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:

Rita Ramos

LICENSING EVALUATOR NAME:

Sabrina Martinez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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