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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419935
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:24:50 AM


Document Has Been Signed on 08/20/2024 10:24 AM - 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:OSCEOLA ELEMENTARY SCHOOL CSPPFACILITY NUMBER:
197419935
ADMINISTRATOR:VELASQUEZ, JOSEFACILITY TYPE:
850
ADDRESS:14940 OSCEOLA STREET RM 1.TELEPHONE:
(818) 362-8456
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:48CENSUS: 22DATE:
08/20/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jose Velasquez, PrincipalTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 08/20/2024 for the purpose of addressing an Action Lead Exceedance (ALE) at the facility. LPA arrived to the facility at 8:50AM and met with Jose Velasquez, Principal, who guided LPA on a tour of the facility. LPA observed 22 children with 5 staff 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 12/06/2022. The sample test for the water fountain identified as Outlet “B” tested at 145 bbp that exceed allowable limit for lead. Test samples testing over 5.5 ppb and above is considered an exceedance.

During today’s visit LPA observed a water outlet inside Room 1 and a water outlet outside of Room 1. Water outlet in Room 1 had a point of use filter dated 10/22/2022. Water outlet located outside of Room 1 had a point of use filter dated 12/21/2022. LPA was not able to confirm which water outlet was Outlet “B”. LPA was not able to verify which outlets were tested because a facility sketch was not provided to the Department prior or during the inspection.

Per Principal, documents were not available at the facility for LPA to obtain copies.
Once documentation for the lead testing is located, 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”. ---Page 1 of 2
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
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 3


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: OSCEOLA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197419935
VISIT DATE: 08/20/2024
NARRATIVE
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During today’s visit LPA took pictures of the water outlets located both inside and outside of Room 1. LPA received a copy of Child Care Center Sampling Checklist Form (LIC 9276).

Documents pending are as followed:
  • External Water Sampler Self-Certification Form (LIC 9275)
  • Facility Sketch identifying the location of water outlet/s used for drinking and tested
  • a copy of the initial water testing results for all outlets
  • proof of correction for Outlet "B"
  • a copy of water retesting results summary for Outlets "B"
  • Plan of correction on how often Outlet "B" filter will be serviced.

Based on interviews, it has been determined that OSCEOLA ELEMENTARY SCHOOL CSPP 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 Jose Velasquez, Principal.
---Page 2 of 2
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/20/2024 10:24 AM - It Cannot Be Edited

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: OSCEOLA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197419935

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2024
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.

This requirement was not met as evidence by:
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Per Principal, the following documents will be submitted to LPA via email by POC due date:External Water Sampler Self-Certification Form (LIC 9275),
Facility Sketch identifying the location of water outlet/s used for drinking and tested, a copy of the initial water testing results for all outlets, proof of correction for Outlet "B", a copy of water retesting results summary for Outlet "B", and
a plan on how often Outlet "B" filter will be serviced.
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Based on interviews, the facility did not comply with the section cited above in the water outlet "B" tested at 145 bbp on 10/18/2022 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 RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3