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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418530
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:05:50 PM

Document Has Been Signed on 10/04/2022 02:05 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:TOLUCA CROSSROADS PRESCHOOLS/KINDERGARTENFACILITY NUMBER:
197418530
ADMINISTRATOR:ARINA FAYNSHTEYNFACILITY TYPE:
850
ADDRESS:4814 CAHUENGA BOULEVARDTELEPHONE:
(818) 980-3688
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 52DATE:
10/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Director Arina FaynshtenTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/04/2022 at 11:55 AM, Licensing Program Analyst (LPA) Antonio Almanza conducted an unannounced case management visit for the purpose of following up on Action Lead Exceedance (ALE), Facility Inspection. LPA met with Director Arina Faynshten and Admistrator/Owner Regina Leybovich and toured the facility. During today’s visit there are 52 children and 7 teachers. Risk Assessment was conducted prior to conducting site visit.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on 09/02/2022. The sample test for the kitchen faucet, located at the back end of Room 6, identified on the facility sketch by letter “D”, tested at 6.9 bbp/ug L, which exceeds allowable limit for lead. Test Samples testing over 5.5 ppb/ug L and above is considered an exceedance.

During today’s visit LPA observed Kitchen Faucet identified on facility sketch. LPA observed the faucet inoperable; the faucet is covered with red plastic box and sign,” Do not use this Sink at all.” The Director is reporting that the sink was used for cleaning art supplies. The facility had the faucet changed on 09/01/22, one day prior to having the lead test. LPA received Invoice dated 09/07/22, for the kitchen faucet replacement.

Licensee has posted testing results, in a location (facility lobby) 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 “D”.

During today’s visit LPA took pictures of the water faucet (D). LPA received an email from the facility with copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276); Facility Sketch (LIC 999) in which all water outlets are noted; and copy of water testing results summary was provided during the visit.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
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.

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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: TOLUCA CROSSROADS PRESCHOOLS/KINDERGARTEN
FACILITY NUMBER: 197418530
VISIT DATE: 10/04/2022
NARRATIVE
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During today’s visit one Type B violation is being issued under Title 22 Regulations, Division 12, and 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.

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.

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. LPA emailed and provided the Director with the Provider Information Notice (PIN) 21-21CCP and Lead Testing in Child Care Centers Frequently Asked Questions.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this Report (LIC809 & LIC809d), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to the Director Arina Faynshten, and Admistrator/Owner Regina Leybovich

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
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 02:05 PM - It Cannot Be Edited


Created By: Antonio Almanza On 10/04/2022 at 01:36 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: TOLUCA CROSSROADS PRESCHOOLS/KINDERGARTEN
FACILITY NUMBER: 197418530

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/10/2022
Section Cited
CCR
101700.3(b)(1)

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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 requirement is not met as evidenced by:
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The facility had the faucet changed on 09/01/22, one day prior to having the lead test. LPA received Invoice dated 09/07/22, for the kitchen faucet replacement.
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Based on observation, interview and record review, The facility Had faucet "D" test with Lead Exceedance of 6.9, which poses a potential Health or Safety, or personal rights risk to persons in care.
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Faucet "D" is inaccessible. Licensee has been preping the water faucet for retesting and will provide LPA with a retest date by 10/10/22.

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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:Antonio Almanza
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


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